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PubMed1998

[Longitudinal study of vascular patients with standardized Brückner distal limb amputation].

OBJECTIVE: The present study aims to evaluate early and late results after standardized below-knee amputation according to Brückner in vascular patients. PATIENTS AND METHODS: During the period 1982 to 1989 72 patients with occlusive arterial disease stage IV underwent below-knee amputation at an average age of 69.7 years. 38 of the amputees could be re-investigated at the end of 1991 after an average follow-up of 5.3 years. Evaluation criteria consisted of wound healing, knee joint preservation, prosthetic fitting, stump appearance, gait capacity or ambulation, the need for assistance by another person and patients own valuation. Accordingly, rehabilitation level was classified to be good, satisfying or dissatisfying. RESULTS: Knee joint preservation rate amounted to 91.7% (66 patients). Postsurgical prosthetic fitting could be achieved in 55 amputees (76.4%). All the 38 re-investigated stumps were inapparent. 27 of the patients (71.1%) showed good and 7 patients (18.4%) satisfying rehabilitation, whereas the rehabilitation level was dissatisfying in 4 cases (10.5%). This objective evaluation was affirmed by patients own estimation: 33 amputees (86.6%) would again agree to the operation. CONCLUSIONS: Early as well as late results in this series indicate that the standardized below-knee amputation according to Brückner promises high rates of healing, knee joint preservation and thus successful rehabilitation in patients with occlusive arterial disease.

Adult↗
PubMed1998

Salvage of a below knee amputation stump with a free sensate total sole flap preserving continuity of the posterior tibial nerve.

We illustrate the use of a free sole flap with intact posterior tibial nerve in the coverage of a below knee amputation 6 months after an explosive injury to a 12-year-old child. We discuss the indications for lower leg amputation in children, modalities of reconstruction of the amputation stump and possible reason for the observed change of colour of the flap persisting for 14 days.

Amputation Stumps↗
PubMed1995

Composite graft survival. An auricular amputation model.

OBJECTIVE: To study the effects of corticosteroids and fibroblast growth factor on composite graft survival using a rabbit model of auricular amputation and reimplantation. DESIGN: Randomized, "blinded," placebo-controlled, prospective animal study. SETTING: Animal laboratory in tertiary care center. INTERVENTION: Amputation of the distal 2 cm of the rabbit ear as a composite graft and reimplantation with simple 6-0 prolene sutures. All animals underwent the same surgical procedure and were randomized into the following four groups: (1) surgical reimplantation alone; (2) 30 mg/kg intramuscular methylprednisolone sodium succinate for 5 days, starting immediately postoperatively; (3) topical basic fibroblast growth factor for 5 days postoperatively; and (4) delayed reimplantation with corticosteroids. In group 4, the ears of the animal were amputated, placed in iced saline containers for 90 minutes, and given 30 mg/kg intramuscular methylprednisolone for 5 days, with the first dose starting immediately prior to reimplantation. MAIN OUTCOME MEASURES: Percentage graft survival and histologic characteristics of viable and nonviable composite graft tissue. RESULTS: The groups that received corticosteroids and delayed reimplantation with corticosteroids had a statistically significant increase in percentage of graft survival compared with the control group (P < .003 and P < .006, respectively). The growth factor group showed no significant difference from the control group. CONCLUSION: Neovascularization occurred in the viable grafts, thus suggesting its role in graft survival. This study establishes the efficacy of corticosteroids in enhancing composite graft survival.

Administration, Cutaneous↗
PubMed1978

A burning issue. Phantom limb pain and psychological preparation of the patient for amputation.

Fantasies concerning an amputated limb can contribute to the occurrence of persistent phantom limb pain. We report a case in which burning pain perceived as located in the amputated lower extremities was related to the patient's feelings about incineration of the removed limbs against her wishes. Hypnotherapy involving elucidation of the fantasy and suggestion was successfully employed in this case and may be a helpful approach in other such cases. Importantly, adequate preparation of the patient for amputation, including an awareness of concerns about the disposition of the limb, may help prevent pathological limb sensations.

Adolescent↗
PubMed1982

Canine osteogenic sarcoma treated by amputation and MER: an adverse effect of splenectomy on survival.

Canine and human osteogenic sarcomas, like most other malignant tumors, cause or are associated with progressive impairment of host immune reactivity. Adjuvant immunotherapy with live BCG had shown increased survival in one study of canine disease. Experiments with induced fibrosarcomas in mice had suggested that some of the host immune defect might be ameliorated by splenectomy. A prospective clinical trial was conducted with several cooperating veterinary centers. Dogs with osteosarcoma apparently confined to a limb were randomized to be treated by amputation and methanol-extracted residue of BCG (MER), or by the same modalities plus splenectomy. Randomization was discontinued relatively early in the study because of higher mortality in the splenectomy group. Animals treated by amputation and MER could be compared only with historic controls; median and one-year survival rates did not differ significantly from those of prior series. Animals treated by amputation, splenectomy, and MER had significantly poorer survival.

Amputation, Surgical↗
PubMed1975

Immediate operative fitting of upper limb prosthesis at the time of amputation.

Three patients are described--2 with an above-elbow amputation and 1 with a through-wrist amputation--in whom a temporary prosthesis was applied on the operating table and in all of whom function was rapidly established. The patients did not become one-handed, with the result that they have all continued to wear their prosthesis throughout their working hours and use their artificial hand for all everday functions. The value of this technique in making the patient accept the prosthesis and therefore to make full use of it suggests that this procedure should be more widely applied in patients who require upper limb amputation.

Adult↗
PubMed1990

Anatomical aspects of the blood supply to the skin of the posterior calf: technique of below-knee amputation.

Whether or not the soleus muscle should be excised during below-knee amputation is a point of contention. The anatomical basis for the blood supply to the skin of the posterior calf has been examined by dissection and selective arterial injection of cadavers. The results showed that the skin used to construct the posterior flap for below-knee amputation derives its blood supply from both axial vessels, running with the peripheral nerves, and perforating vessels arising through the gastrocnemius muscle. There is no contribution by blood vessels that pass through the soleus muscle. When a posterior flap for below-knee amputation is constructed the soleus muscle should be completely excised.

Amputation, Surgical↗
PubMed1992

Success rates for rehabilitation of vascular amputees: implications for preoperative assessment and amputation level.

All lower limb amputations performed during 1986 and 1988 in eight hospitals in the south-east region were assessed. Of 440 amputations for vascular disease, 193 were above-knee, 193 below-knee, 15 Gritti-Stokes, 15 through-knee and 24 bilateral. Of the 440 patients, 75 died in hospital, 113 were considered unsuitable for a prosthesis and 252 (57 per cent) were referred for prostheses. Rehabilitation questionnaires were sent to 179 patients (41 per cent), as a further 54 had died and 19 had become known non-wearers before the study commenced. The response rate was 81 per cent; 102 patients completed the questionnaire, 21 were reported dead, and 22 were non-wearers. Of a maximum rehabilitation score of 12, 52 patients scored 6 or more (consistent with mobility on their artificial limb around the home), and 21 scored 9 or more (a standard accepted as successful rehabilitation). It is concluded that 10-15 per cent of amputees achieve mobility around the home on their prosthesis. Only 5 per cent, however, rehabilitate well and become independent of their wheelchair. When amputation is inevitable, more consideration should be given to surgery that optimizes wheelchair rehabilitation.

Aged↗
PubMedDate not supplied

Factors that influence the level of activities in persons with lower extremity amputation.

This study explored the problems of prosthesis use in four dimensions of activity in 122 males and 9 females, aged 24 to 90 years, with lower extremity amputations. Comparisons were made between persons with above-the-knee amputation and those with below-the-knee amputation. A four-dimensional prosthetic problem inventory scale developed by the investigators was used. Results of this study provide a framework for identifying and addressing problematic areas in the use of prostheses.

Activities of Daily Living↗
PubMed1995

Acquisition of nerve dependence for the formation of a regeneration blastema in amputated hindlimbs of larval Xenopus laevis: the role of limb innervation and that of limb differentiation.

In larval and adult urodeles and late-stage larval anurans, blastema formation after limb amputation requires an adequate nerve supply. Experimental evidence obtained from aneurogenic limbs indicates that, in urodeles, the acquisition of nerve dependence during embryonic development is due to the "addiction" of limb tissues to factors released by the ingrowing nerves rather than to limb differentiation. The aim of this work was to establish whether, in the toad Xenopus laevis, nerve-dependence for blastema formation after hindlimb amputation, which is acquired gradually during larval development and becomes complete at stage 57 is due to limb innervation or to limb differentiation. Two series of experiments were carried out. In the first series, limb differentiation was inhibited by treating the larvae with an anti-thyroid drug, and innervation was maintained for an interval much longer than that normally required for development from nerve-independent stages to stage 57. In the second series, the limb was caused to differentiate in the absence of nerves by maintaining the limbs denervated. Limb differentiation was often accelerated by treating early-stage larvae with thyroxine or by grafting early-stage limbs onto denervated limbs of late larvae, which, being near metamorphic climax, possessed high levels of circulating thyroid hormones. Results showed that in the first series of experiments the denervated limbs formed regeneration blastemas after amputation, but in the second series they did not. It was therefore concluded that the acquisition of nerve dependence for blastema formation in larval Xenopus laevis is not directly imposed by factors released by the nerve fibers, but is strongly related to differentiation of limb tissues.

Amputation, Surgical↗
PubMed1984

Response of amputated rat limbs to fetal nerve tissue implants and direct current.

We have previously shown that implanted fetal nerve tissue stimulates the regeneration of amputated chick limbs. The purpose of this study was to determine whether a similar phenomenon would occur in amputated rat limbs and if addition of applied direct current (DC) would affect this process. Thus, fetal nerve tissue was implanted into amputated stumps of 3-week-old rats; variable tissue regeneration was induced that was dependent on the age of the donor implant and the presence of applied DC. Twelve or 14 day fetal neural implants induced new accessory bones containing epiphyseal plates and marrow cavities and occasionally formed joint-like structures with the host humerus. Addition of DC to 12 day neural implants increased the number of new bones formed. Eighteen day neural tissue with applied DC did not induce new bone formation but stimulated the maximal elongation of the host humerus and outgrowth of nerve fibers to the cut surface. Implantation of fetal heart tissue or implantation of fetal neural tissue into unamputated limbs failed to induce new bone formation. Although true limb regeneration was not achieved, formation of new skeletal elements did occur and this effect was enhanced by applied DC.

Amputation Stumps↗
PubMed2001

Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: indications, preoperative evaluation, surgical technique, and results.

BACKGROUND AND OBJECTIVES: Uncontrolled metastatic carcinoma of the shoulder girdle is a difficult oncologic problem. This study reviews our experience with palliative forequarter amputation with emphasis on patient selection criteria, preoperative radiologic assessment, surgical technique, epineural postoperative analgesia, and clinical outcome. METHODS: Eight patients who underwent palliative forequarter amputation for metastatic carcinoma between 1980 and 1999 were analyzed retrospectively. Diagnoses included breast carcinoma (n = 3), squamous cell carcinoma (n = 2), hypernephroma (n = 2), and carcinoma of unknown origin (n = 1). All patients presented with severe, intractable pain and a useless extremity. Venography demonstrated obliteration of the axillary vein in each of the patients in whom this procedure was performed. Exploration of the brachial plexus confirmed tumor encasement and unresectability in all patients. Epineural catheters for bupivacaine infusion were placed for postoperative pain control. RESULTS: All patients experienced dramatic pain relief and improved mobility and overall function. Life-threatening hemorrhage and sepsis were alleviated. There were no instances of phantom limb pain or adverse psychological reactions, and no complications related to epineural analgesia. CONCLUSIONS: Palliative forequarter amputation is relatively safe and reliable and provides effective pain relief for selected patients with unresectable metastatic carcinoma to the axilla and bony shoulder girdle in whom radiotherapy and/or chemotherapy has not been effective. The triad of pain, motor loss, and an obliterated axillary vein is indicative of brachial plexus infiltration and unresectability.

Adult↗
PubMed1992

The feasibility of hind foot amputation in selected sarcomas of the foot.

The treatment of foot sarcomas is generally a below knee amputation. In selected sarcomas of the forefoot, however, a transtarsal amputation according to Chopart, a calcaneotibial arthrodesis according to Pirogoff, or a supramalleolar amputation according to Syme can be considered the treatment of choice, leading to an optimal functional outcome.

Adult↗
PubMed1992

Quality of life in bone tumor patients comparing limb salvage and amputation of the lower extremity.

In 33 long-term survivors of lower extremity bone cancer quality-of-life data were studied following limb salvage compared to amputation. Self-report questionnaires, semistructured interviews and visual analog scales were used to measure psychoneurotic and somatical distress, activities of daily living, self-esteem, and adjustment to illness. Fourteen patients with limb salvage (age 13-56 years, median 24) and 19 patients with an amputation (age 21-53 years, median 27) were evaluated 2-17 years (median 10 years) after surgery. The differences between the two groups were not statistically significant. However, physical complaints were reported more often by limb salvage patients, whereas the amputees showed a trend toward lower self-esteem and isolation in social life, due to their disability. Both groups felt equal diminution of quality of life and disability as measured on the visual analog scale. These findings could support the cosmetic advantage of limb salvage compared to amputation.

Adolescent↗
PubMed1987

Second toe transfer for thumb reconstruction in multiple digit amputations including thumb and basal joint.

Amputation of the thumb, including the basal joint, is a disabling injury that leaves limited reconstructive options. Three cases of multiple digit amputation including the thumb and basal joint are presented in which a second toe transfer was used to reconstruct the thumb. All patients have functional pinch with an average pinch strength of 27% of the opposite uninjured extremity. The average grip strength for two patients is 44% of the opposite hand. Average motion of the transfer at the MP, PIP, and DIP is 25 degrees, 37 degrees, and 9 degrees, respectively. Adduction and abduction are obtained, the degree depending on the site of proximal bony fixation. No patient has morbidity at the donor site and all are happy with their reconstruction. In selected cases we feel second toe transfer is an excellent choice to reconstruct the thumb amputated at a proximal level.

Adult↗
PubMed1990

One hundred eleven thumb amputations: replantation vs revision.

One hundred eleven patients who sustained isolated, complete thumb amputation between 1971 and 1985 were reviewed to assess results of replantation and to compare these with results of amputation revision. Routine postoperative evaluation was performed in 69 successful replant patients and in 42 with revision. Twenty-five of the replant group and 18 of the revision group returned for additional testing that consisted of interview and physical examination, test of activities of daily living, Jebsen test of hand function, and both static and dynamic testing on the BTE work simulator. Ninety percent of replantations were between the metacarpophalangeal (MCP) joint and the proximal third of the distal phalanx. Shortening averaged 11 mm, and range of motion was 42% +/- 28% that of the uninjured thumb. One-half of the patients could touch the MP of their ring finger, and one-fourth could touch the proximal interphalangeal (PIP) joint. Twenty-one percent had 7 mm or less two-point discrimination, and 38% had between 8 and 20 mm. Eighty percent of both groups were able to perform activities of daily living at 80% of their uninjured side. Grip strength was approximately 84% of that of the uninjured hand in each group. Lateral pinch averaged 68% +/- 26% of that of the normal side in the replant group and 91% + 9% in the amputation group. Work simulator assessment of lateral and three-point pinch was better in the revision group. Scores on Jebsen testing were slightly better for those with replanted thumbs, but in general neither replant nor revision patients functioned as well as did Jebsen's normals.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Transpositional microsurgery in multiple digital amputations.

In 34 of the 62 patients treated for complete multiple digital amputations, the severed part was not replanted in its anatomical position, but in the place of the most useful stump. This procedure is defined as transpositional digital microsurgery and refers to the transposition and replantation of any digit to another stump which plays a more significant role in the function of the hand. Twenty-eight patients had transposition of a digit, while six patients underwent thumb transposition. All except six of the transposed digits survived, while all of the thumbs survived the surgical procedure. The cosmetic appearance of the hand with a transposed digit or thumb was acceptable to the patients. Two-point discrimination was assessed to be 10-14 mm for the transposed digits, and the functional ability of the transplanted digit was comparable to digits which were replanted in their anatomical position. In conclusion, transpositional digital microsurgery remains a useful alternative for the treatment of multiple digit amputations, particularly in patients with severely damaged non-replantable amputated parts.

Adult↗
PubMed2006

Reliable option for reconstruction of amputation stumps: the free anterolateral thigh flap.

The increased use of microsurgery has enabled reconstructive surgeons to deal with tissue defects of various sizes and compositions. The limited amount of qualified tissue for covering is the primary problem in stump reconstruction. Free flaps offer the ideal solution by providing the optimal cover, and by preserving the length of the amputation site. Anterolateral thigh flaps were preferred for reconstruction of lower extremity amputation sites of nine patients admitted both in the subacute and chronic periods. All underwent previous stump reconstruction with local flaps in other clinics. Anterolateral thigh flaps avoided further shortening of the extremities, and provided stable tissue for prosthesis use. The flap offers reliable soft-tissue reconstruction of amputation stumps.

Adolescent↗