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PubMed2006

DNA degradation in nuclei of muscle cells followed by ischemic injury in a rabbit amputation model.

This study evaluated DNA degradation in nuclei of muscle cells during ischemia in a rabbit limb amputation model. Seven New Zealand rabbits were used. The left rear limb of the animal was amputated. The quadriceps femoris muscle was biopsied, as well as the rabbit carotid arteries. Half of the tissue samples were preserved at a cold temperature (2-4 degrees C), and the other half were kept at room temperature (25 degrees C, global ischemia). Immediately and 4, 8, 12, 16, and 24 h after amputation, muscle tissue samples were stained with the Feulgen reaction and analyzed by an image-analysis system to detect DNA contents in muscle cell nuclei. Samples from carotid arteries were examined with a transmission electron microscope. The results showed that the DNA content in muscle cell nuclei was slightly decreased at 4 and 8 h of global ischemia. At 12 h after global ischemia, the DNA content was found to be significantly decreased (80.03% of baseline). The DNA content dropped to 53.93% of baseline at 16 h of global ischemia. However, in the muscle that was preserved at cold temperature, the DNA contents were only slightly changed along with the ischemia time at 24 h. The DNA changes were confirmed by transmission electron microscopic observations. The present findings could provide evidence for the study of revascularization of ischemic muscle.

Amputation, Surgical↗
PubMed1992

Amputation for occlusive arterial disease. A prospective multicentre study of 177 amputees.

All major amputations of the lower limb due to occlusive arterial disease were studied prospectively and consecutively during one year in the 5 hospitals in Malmöhus county, Sweden. The patients were followed for 6 months after the primary amputation of which 136 were through the tibia, 6 through the knee and 35 through the femur. One hundred and seventy-seven patients (92 men and 85 women) were included; 49% were 80 years or older and 40% were diabetic. At 6 months, 85 of the surviving 109 patients had healed stumps, 10 were not healed and 14 had been revised or reamputated. Half the survivors used a prosthesis daily. There was no significant difference in healing related to sex, age, diabetes or the level of amputation, but diabetics were more often bilateral amputees. The mortality at 6 months was 38% and at 4 years 72%.

Adult↗
PubMed1986

[Indications for immediate and delayed amputation in severe soft tissue and skeletal injuries of the distal tibia].

Primary amputation of the lower extremity has become rare in the last years due to the advances in rigid fixation of the bone, plastic and microsurgical techniques and aseptic surgery. Primary amputation is indicated in the presence of non-reconstructable lesions of vessels and/or nerves, secondary amputations when vascular, neural or septic complications occur.

Amputation, Surgical↗
PubMed1995

Further study on the vascular basis for the reimplantation of the hand amputated through the palm.

Based on the anatomic data obtained from earlier studies on the vascular anatomy of the hand, the vascular architecture in the palm of the hand was studied on 60 sides of unembalmed adult upper extremities. Each palm was divided into 64 squares by 8 sagittal and 8 transverse sections. The vascular architecture in these squares and the arterial relations between them were observed and measured by angiography, operative microscopic dissection and computerised three-dimensional reconstruction. According to the pattern of the blood-vessels, the amputated palms can be classified into 4 types. The anatomic basis for the vascular anastomosis in each type is defined. There are three key-areas for the blood-supply of the palm and their significance is discussed. Apart from the 4 types of transversely amputated palms, the repair program of the blood-vessels in 4 types of common obliquely amputated palms are also discussed.

Amputation, Traumatic↗
PubMed1993

Effects of the development of modern vascular services on amputation rates in Leicester, U.K.: a preliminary report.

We have reviewed 3036 consecutive patients who underwent arterial reconstruction, percutaneous transluminal angioplasty, or a major amputation for lower limb peripheral vascular disease in Leicester between 1974 and 1990. Patient data were obtained from the Hospitals Activity Analysis database, which codes all patient discharges according to diagnosis and treatment. During this 17-year study period, 1132 patients have undergone arterial reconstruction, 706 patients have undergone percutaneous transluminal angioplasty, and 1198 patients have undergone major amputation. The results show that the number of arterial reconstructions and angioplasties for lower limb arterial occlusive disease has increased over the last 17 years. The total amputation rate has decreased slightly during the period studied, but overall the decrease has not been significant.

Amputation, Surgical↗
PubMedDate not supplied

Mortality, major amputation rates, and leukopenia after isolated limb perfusion with phenylalanine mustard for the treatment of melanoma.

BACKGROUND: Isolated limb perfusion (ILP) is a treatment for cutaneous melanoma performed by several centers worldwide. The final data analysis of the World Health Organization and European Organization for Research and Treatment of Cancer in the use of ILP as adjuvant treatment for cutaneous melanoma is pending. ILP is effective to treat recurrent cutaneous melanoma. We determined the published rates of morbidity and mortality of ILP and put that component of the procedure into contemporary perspective. METHODS: A MEDLINE search was conducted of the English-language literature from 1980 to 1995 for all publications reporting perfusion with phenylalanine mustard alone or combined with other agents. Patients treated by staged perfusion or fractional doses of chemotherapy were excluded. All published series were analyzed for the rate of mortality, number of major amputations, and presence of leukopenia. RESULTS: The 30-day mortality rate for > 2,000 patients was 0.6%. Death often resulted from cardiopulmonary complications or overwhelming sepsis from leukopenia. Leukopenia occurred in 0.7% of patients reviewed, caused by leakage of chemotherapeutic agents into the systemic circulation. Major amputations occurred in 0.8% of patients, and most were of the lower extremity. CONCLUSIONS: The definition of efficacy of ILP in the treatment of extremity melanomas remains to be clearly defined. However, based on this review of worldwide publications, the risk of death, amputation, and leukopenia is low.

Amputation, Surgical↗
PubMed1996

Major lower limb amputation in diabetic patients: development during 1982 to 1993.

This study analyses 2848 primary major lower limb amputations in diabetic individuals during the period 1982-1993. The male:female sex ratio (mean 1.18) increased, while the mean age at the primary amputation was constant (70.96 years) during the period. The incidence uniformly decreased for both men and women by 0.96 per year. A subdivision of the total population into three age groups (< 50, 50-70, > 70 years), shows a 0.95 decrease per year with no significant difference between the groups. The decrease in incidence during the period 1987-1993 appeared specifically related to insulin-dependent diabetes mellitus (0.92), whereas the incidence of amputations in non-insulin-dependent diabetic patients was constant. The overall decrease of incidence during the period (40%) does not fully meet the target specified in the St. Vincent Declaration.

Adult↗
PubMed2003

[Amputation or limb salvage? Assessing quality of life after tumor operations of the lower extremity].

The purpose of this study was to compare quality of life and subjective well-being between patients who underwent either amputation or limb-salvage procedures for lower extremity sarcomas in order to determine if this aspect can be considered in the decision on the type of surgery. Sixty-six patients were evaluated at least 1 year after surgery and systemic therapy for lower extremity sarcomas. Self-report questionnaires such as the Quality of Life Questionnaire (QLQ-C30), the Life Satisfaction Questionnaire (FLZ), and the Enneking Score (MSTS) were used. There were no differences in quality of life and subjective well-being between the two groups. Scores of the symptom scale (14.1 vs 13.2), the global quality of life (70.9 vs 71.0) as well as scores of the function scale (51.7 vs 50.3) were similar. Small differences in scores were found in social functioning but not in scores of physical, cognitive, and emotional functioning. Global subjective well-being in both groups was also similar (219.5 vs 223.7). High satisfaction was found in marital life and partnership as well as in self-assessment. The least satisfaction was found in finances. Results in functional outcome after limb-salvage procedures (77% vs 65%) were better. Although more complications were reported after limb-salvage procedures, they did not seem to have any impact on quality of life ( p=0.235, r(p)=0.112) and subjective well-being ( p=0.856, r(p)=0.140) of the patients whereas a correlation to function could be shown ( p<0.001, r(p)=0.595; p=0.015, r(p)=0.304). Additionally, a correlation between subjective well-being and the location of either amputation or reconstruction ( p=0.039, r(p)=- 0.309) could be shown. These findings demonstrate that the type of surgery has no influence on quality of life and subjective well-being after lower extremity sarcomas. Thus the decision for either limb-salvage procedures or amputation cannot be based on quality of life and subjective well-being but must be determined by oncological criteria.

Activities of Daily Living↗
PubMed2001

[Amputation of the lower extremity in paraplegic patients. Etiology, sequelae and patient management].

Up to now, there are not many reports about indications and guidelines for prosthetic fitting in amputated paraplegics and tetraplegics. In a review of 35 spinal cord patients with 42 amputations of the lower extremity, data on the neurological level, cause of injury, level of amputation, long-term complications, prosthetic fitting, and usage of the prostheses in daily life are presented. Everyday usage of the prostheses is reported for 15 patients.

Adult↗
PubMed2003

Problems of amputation surgery in a developing country.

We studied prospectively 87 patients who underwent extremity amputation in the National Orthopaedic Hospital in Lagos in 1995-1996. Trauma from road traffic accident was the most common indication (34/87) with peripheral vascular disease being the least encountered (2/87). Traditional bonesetters' gangrene accounted for 9/87 cases in circumstances that were largely avoidable. Our study revealed that amputation is still being performed as a life-saving procedure, as 44/87 patients presented with gangrene of a limb. The nonavailability of special investigations such as Doppler ultrasound, arteriography, and CT scan was responsible for a delay in definitive treatment in 28 cases. Poor prosthetic services and the absence of a well-coordinated amputee clinic were responsible for some of the unsatisfactory results. We believe that the availability of specialized diagnostic tools and facilities for microvascular surgery, together with a multidisciplinary approach to the management of the amputee, would considerably change the current gloomy picture of amputation in developing countries such as Nigeria.

Adolescent↗
PubMed2003

Sural flap vascularization in arteritic patients: an anatomic study of 24 amputation specimens.

Obliterating arteriopathy of the lower limbs is a classic contraindication for neurocutaneous islands flaps, particularly the sural flap. But recent literature reports examples of its successful application in arteritic patients. The aim of this work was to study the vascular anatomy of the sural flap in patients suffering from arteriopathy and its possible clinical application. Twenty-four specimens of leg amputation were studied. The mean age of the amputated patients was 68.5 years. The clinical signs of arteriopathy had been present for 3-16 years. In 10 cases amputation was carried out directly, in 14 cases after failed revascularization. The results of the dissection showed the theoretical possibility of a sural flap in almost all the cases (23 of 24) despite certain anatomical peculiarities. In the upper part of the leg the arterial network of the sural communicating nerve dominates that of the sural nerve; this should allow the use of a sural flap centered on this vascular axis. In the lower part, the arterial network of the sural communicating nerve is sustained by the perforators of the peroneal artery, then by the branches of the calcaneal artery, and finally by the lateral tarsal artery, which should allow the use of a sural flap with a very distal pedicle. The authors propose a theory which suggests that the progressive evolution of arteriopathy and the concomitant development of a supply network involving the vascularization of the sensory nerves induces the "anticipation" of a sural flap.

Aged↗
PubMed2000

Osseous overgrowth after post-traumatic amputation of the lower extremity in childhood.

Severe accidents in children may cause extreme destruction of the lower extremities. In some cases, there is no possibility to preserve the limbs. Initially, a weight-bearing stump cannot be achieved after amputation due to unstable local and soft tissue conditions. This critical situation is often complicated by one of the leading problems in the limb-deficient child - the development of osseous overgrowth. Bizarre overgrowth of the stump may lead to skin perforation, pressure ulcers, and difficulties with the prosthesis. Since 1993, we have been able to follow five pediatric and adolescent patients (2 years to 17 years old) with six post-traumatic amputations of the lower extremities. Four of these cases developed osseous overgrowth. One child treated with initial autologous stump-capping had excellent soft tissue conditions and no problems with the artificial limb. We also report on a case of bizarre and extensive new bone formation. We conclude that close follow-up visits after post-traumatic amputations in children are essential because of new bone formation which may endanger the soft tissue situation of the stump. Unfortunately, surgical revisions have to be performed quite often. To avoid several surgical corrections, an initial stump-capping with autologous material from the injured limb can be performed. Thus, the number of secondary procedures may be reduced drastically.

Adolescent↗
PubMed2004

Reducing the incidence of foot ulceration and amputation in diabetes.

Diabetes is a common disease that is associated with numerous complications, including foot ulceration and amputation. In diabetic patients, the incidence of foot ulcers ranges from 1.0% to 4.1%, and the incidence of lower-extremity amputations ranges from 2.1 to 13.7 per 1000. Risk factors for developing foot ulcers and subsequent amputation include neuropathy, peripheral vascular disease, and trauma. To reduce these complications, several preventive strategies have been devised, from reducing risk factors to improving treatment and management.

Amputation, Surgical↗
PubMed1986

Giant cell arteritis of the legs. Clinical isolation of severe disease with gangrene and amputations.

Giant cell arteritis rarely presents as clinically advanced extra-ocular ischemia or gangrene. Clinically isolated leg involvement with amputation is even more unusual. A 69-year-old woman is described who had giant cell arteritis necessitating bilateral leg amputations. No other clinical sequelae have ensued during a four-year follow-up period. Temporal artery biopsy subsequent to the amputations revealed no arteritis. Disparities between the usual patterns of clinical and anatomic involvement in giant cell arteritis underlie the potential diagnostic difficulties in this disease. Although typically diagnostic, temporal artery biopsy does not always bridge the clinical and anatomic disparities.

Aged↗
PubMed1979

Lower extremity amputation: review of 110 cases.

Very significant morbidity and mortality continue to accompany lower extremity amputations. In this study 90 patients underwent 110 amputations over a 4 year period. The overall complication rate was 40 per cent and the overall mortality rate 12.2 per cent. The patients at greatest risk were the above knee amputees greater than 60 years of age with peripheral vascular disease. Amputation of the lower extremity must be recognized as a major, life-threatening procedure. Careful preoperative evaluation of cardiac, pulmonary, and nutritional status along with efforts to prevent sepsis, pneumonia, pulmonary embolism, gastrointestinal ulceration, and renal failure are necessary if the mortality accompanying these procedures is to be reduced.

Adult↗
PubMed1983

Contralateral limb and patient survival after leg amputation.

Fifty-three patients who required amputation for ischemic disease of the legs were evaluated actuarially. The incidence of subsequent contralateral amputation and the length of patient survival were found to be nearly identical to incidence rates reported during the 1960s. The diffuse end-stage nature of the atherosclerotic process which led to the initial amputation in both time periods accounted for the similarity. Operative mortality decreased from more than 10 percent to 1.5 percent, presumably because of improved cardiovascular support and early rehabilitation.

Adult↗
PubMed1987

Prospective comparison of noninvasive techniques for amputation level selection.

This study prospectively compared the following tests for their accuracy in amputation level selection: transcutaneous oxygen, transcutaneous carbon dioxide, transcutaneous oxygen-to-transcutaneous carbon dioxide, foot-to-chest transcutaneous oxygen, intradermal xenon-133, ankle-brachial index, and absolute popliteal artery Doppler systolic pressure. All metabolic parameters had a high degree of statistical accuracy in predicting amputation healing whereas none of the other tests had statistical reliability. Amputation site healing was not affected by the presence of diabetes mellitus nor were the test results for any of the metabolic parameters.

Adult↗
PubMed1989

Prevention of amputation by diabetic education.

This prospective randomized study evaluated the influence of a simple education program on the incidence of lower extremity amputation in diabetic patients. Two hundred three patients were randomized into two groups: Group 1, education (103 patients, 203 limbs) and Group 2, no education (100 patients, 193 limbs). There were no significant differences in medical management or clinical risk factors between the two groups. The amputation rate was three times higher in Group 2 (21 of 177 limbs versus 7 of 177 limbs; p less than or equal to 0.025), the ulceration rate was three times higher in Group 2 (26 of 177 limbs versus 8 of 177 limbs; p less than or equal to 0.005), and there was no difference in the overall incidence of infection (2 of 177 limbs). Overall success in Group 1 was highly significantly different from Group 2 (160 of 177 limbs versus 128 of 177 limbs; p less than or equal to 0.0005). This study demonstrated that a simple education program significantly reduced the incidence of ulcer or foot and limb amputation in diabetic patients.

Amputation, Surgical↗