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PubMedDate not supplied

Nonpsychotic, nonparaphilic self-amputation and the internet.

The literature suggests that self-amputation is an outgrowth of either psychosis or paraphilia. In the case we present, the patient was neither psychotic at the time of amputation, nor did he ascribe a sexual motivation for his act. Instead, he had a long-standing idea that being an amputee was a critical aspect of his identity. The patient used the internet to research the method for his amputation and sought support from individuals with the same desire via e-mail, web sites, and Usenet news groups.

Amputation, Surgical↗
PubMed2005

Transmetatarsal amputations.

Transmetatarsal amputation is an excellent procedure in the face of nonhealing ulceration, infection, trauma, peripheral vascular disease, and tumors. This article discusses transmetatarsal amputations, the decision-making process, timing of surgery, operative techniques, postoperative management, and salvage of the failed transmetatarsal amputation.

Amputation, Surgical↗
PubMed2006

A randomised controlled trial of the use of a tourniquet to reduce blood loss during transtibial amputation for peripheral arterial disease.

OBJECTIVES: To examine the effects of an exsanguination tourniquet on blood loss during transtibial amputation in patients with peripheral arterial disease (PAD). DESIGN: Prospective randomised blinded controlled trial. MATERIALS AND METHODS: Sixty-four patients undergoing transtibial amputation for non-reconstructible PAD were randomised to either tourniquet or no tourniquet (control). Blood loss (primary outcome), fall in haemoglobin, transfusion requirements, wound healing, breakdown and revision (secondary outcomes) were also recorded. RESULTS: Twenty-five patients in the tourniquet and 29 in the control group conformed to the trial protocol and completed the follow up. Intra-operative blood loss (median and IQR) was significantly greater in the control group compared to the tourniquet group (550 ml (255-1050) vs 255 ml (150-572.5), respectively, p=0.014, Mann-Whitney). There was a significantly greater drop in haemoglobin concentration (median and IQR) in the control compared to the tourniquet group (1.8 g/dl (0-1.2) vs 1.0 g/dl (0.6-2.4), p=0.035, t-test). Transfusion requirements were lower in the tourniquet group (p=0.05, Mann-Whitney). The rate of wound healing, breakdown and revision were similar in the tourniquet and control groups, respectively (59 vs 57%, 0 vs 9%, 14 vs 9%, p=NS). CONCLUSIONS: The use of a tourniquet during transtibial amputation for severe PAD reduces blood loss and need for blood transfusion.

Aged↗
PubMed2004

Amputations of the hand and upper extremity in the management of malignant tumors.

The primary goal of treatment for malignant bone and soft tissue tumors of the hand and upper extremity is an oncologic cure. The secondary goal is maintenance of function. Despite recent advances in chemotherapy and radiation techniques, amputation still provides a means for achieving surgical cure for some bone and soft tissue sarcomas. A well planned amputation with attention to level, soft tissue closure, muscle transfer as needed, and nerve handling combined with early fitting of modern prosthetic devices provides patients with a rapid return to normal activity. This article reviews the general principles and specific techniques of amputation in the patient with an upper extremity malignancy.

Amputation, Surgical↗
PubMed2004

Trans-metatarsal amputation as a complication of child sexual abuse.

A case of chronic physical abuse and acute sexual abuse via anal penetration complicated with disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and subsequent bilateral trans-metatarsal amputation is reported. A 13-year-old male presented with old cigarette burns on his chest and acute anal laceration. Four days after laceration repair, he developed DIC and ARDS. The child had to undergo bilateral trans-metatarsal amputation. Due to the systemic defects of the child protection system in Turkey, sexual and physical abuse were recognized by medical personnel 45 days after admission, child protective services never got involved, and prosecution failed to punish the perpetrator(s) of this extreme victimization. This is the only reported case of bilateral trans-metatarsal amputation due to sexual abuse complicated with DIC and ARDS. Social and medico-legal management of sexual abuse is suboptimal in Turkey. Within that context, professionals should be trained on how to recognize, assess, diagnose and manage victims of child abuse and neglect.

Adolescent↗
PubMedDate not supplied

Change in amputation rate in a Turkish diabetic foot population.

Diabetic foot, an important cause of morbidity and mortality, is an important economic problem in all countries. We examined the duration of diabetes, ratio of hospitalization, and the amputation rates of our diabetic foot patients between 1996 and 2002 and compared the results with those obtained between 1985 and 1995. Medical reports of 117 patients with diabetic foot referred to Gazi University Medical Faculty between 1996 and 2002 were retrospectively analyzed. The mean age was 61.09+/-10.87 years and mean duration of diabetes was 16.14+/-9.44 years. Sixty-one patients were hospitalized and 56 patients were followed in our outpatient clinic. The mean duration of hospitalization was 45.00+/-18.74 (20-74) days in amputees and 28.95+/-11.61 (10-47) days in the nonamputees (P=.023). The mean age and duration of diabetes were significantly higher in amputees in the present group than that in the previous group. The amputation rate was significantly lower in the group studied between 1996 and 2002 compared to the group followed between 1985 and 1995 (9.4% vs. 21%, respectively, P<.001). Appropriate diabetes education and systematic follow-up in an outpatient clinic may delay preventable diabetic foot lesions and reduce the amputation rate.

Age Factors↗
PubMed2005

Hand replantations following complete amputations at the wrist joint: first experiences in Hanoi, Vietnam.

Five completely amputated hands at the level of the wrist joint were replanted. The five patients were all men, ranging from 19 to 31 years and the amputations were all the result of knife injuries. All the revascularizations were successful. Secondary tenolysis was required in one case. Postoperative functional results compared to the uninjured hand were evaluated according to five main criteria: (1) the patient's overall satisfaction with the hand; (2) recovery of flexor and extensor function of the thumb and fingers; (3) recovery of thumb opposition; (4) recovery of sensitivity in the median and ulnar nerve distributions; (5) ability of the surviving hand to perform daily tasks. The results showed that, although the replanted hands were never functionally as good as the contralateral hand, the patients were able to use them satisfactorily for activities of daily living. Our results demonstrate that replantation following complete amputation at the wrist joint level as a result of a sharp injury is extremely worthwhile and has excellent potential for functional recovery.

Activities of Daily Living↗
PubMed2004

Theory-guided intervention for preventing diabetes-related amputations in African Americans.

A disproportionate number of individuals of African American descent undergo lower extremity amputations because of complications from diabetes mellitus (American Diabetes Association 2001). It is estimated that up to 85% of lower extremity amputations can be prevented through programs for preventing and treating foot ulcers, preventing reoccurrence of ulcers, and educating patients about proper foot care (American Diabetes Association 2001). The primary purpose of this article is to describe a church-based educational intervention that was developed to assist individuals of African American descent in the prevention of lower extremity amputations resulting from diabetes. The intervention was designed with the Health Belief Model as the framework. The secondary purpose of this article is to demonstrate the feasibility of using the Roy Adaptation Model as a framework for the same intervention. A comparison of the two frameworks is intended to support the use of the Roy Adaptation Model as a useful guide in the development of community-based nursing interventions. The current nursing literature (based on a search in CINHAL 1995-2003 and MEDLINE 1995-2003) exhibits an abundance of use of health behavior theories not authored by nurses that are used to guide interventions. The comparison of a health promotion model such as the Health Belief Model and a nursing theory is essential to address the relative lack of presence of the use of nursing theories in the realm of health-promoting interventions by nurses.

Adaptation, Psychological↗
PubMed1990

Amputation prevention in an independently reviewed at-risk diabetic population using a comprehensive wound care protocol.

An independent review panel composed of an orthopedic surgeon, a vascular surgeon, and an endocrinologist was convened to conduct a case history review. The 71 patients reviewed had 124 wounds on 81 limbs and participated in the comprehensive wound management program of the University of Minnesota. Based on their expertise, the review panel classified the wounds by severity and identified the limb's risk for amputation. The resulting scores were then compared with the patient's actual outcome. The review panel predicted 65 (80%) of the limbs would be salvaged and 16 (20%) would be amputated. The actual outcome was that 75 (93%) of the limbs were salvaged and 6 (7%) were amputated (p less than 0.005). The university's wound management program was highly successful, compared with the predictions of the reviewers.

Amputation, Surgical↗
PubMed1995

Factors influencing limb salvage and survival after amputation and revascularization in patients with end-stage renal disease.

BACKGROUND: Critical lower-extremity ischemia in patients with end-stage renal disease is associated with high operative mortality and low rates of limb salvage. PATIENTS AND METHODS: The outcomes of 102 operations for lower-extremity ischemia in 77 patients with end-stage renal disease were analyzed to determine predictors of limb salvage and operative survival. RESULTS: Patients undergoing amputation (n = 50) and revascularization (n = 52) were similar in age, cause, and duration of renal failure, and prevalence of coronary artery disease. Operative mortality was 13% in revascularized patients and 20% in amputated patients, and was caused by sepsis in 12 of the 17 deaths (71%). Limb salvage in surviving patients was 91% at 30 days and 67% at 1 year. One-year survival was 72% in both groups. Factors associated with limb loss included advanced generalized atherosclerosis, extensive tissue necrosis, failed ipsilateral bypass, and poor cardiac functional status. Overall, factors associated with mortality included failure of limb salvage procedures, hemodynamic instability, and poor cardiac functional status. CONCLUSIONS: More liberal use of primary amputation for end-stage renal disease patients with critical leg ischemia appears to be an important factor in improving both limb salvage rates and overall operative mortality.

Amputation, Surgical↗
PubMed1987

Changes in glucose metabolism in submandibular salivary glands of rats after isoproterenol or incisor-tooth amputation.

Rats were injected daily with isoproterenol (2 mg/kg of body wt) for up to five days, or their incisor teeth were amputated on every other day for up to five amputations. The animals were subdivided in two subgroups killed 12 or 24 h after the first or last intervention. At 12 h all enzymes except hexokinase (HK) and pyruvate kinase (PFK) showed decreased activities after isoproterenol. After incisor amputation, only increased HK and PFK activities were observed. With both procedures, there is activation of beta-adrenergic receptors but results show that different biochemical events take place, suggesting different mechanisms.

Amputation, Surgical↗
PubMed2000

Walking symmetry and energy cost in persons with unilateral transtibial amputations: matching prosthetic and intact limb inertial properties.

OBJECTIVES: To investigate the hypothesis that increasing the mass and moment of inertia of the prosthetic limb of people with unilateral, transtibial amputations to match the mass and moment of inertia of the intact limb improves walking symmetry without increasing energy cost. DESIGN: Gait symmetry and metabolic energy cost of walking for six subjects with unilateral, transtibial amputations were evaluated under three prosthesis loading conditions. SETTING: University research laboratory. SUBJECTS: Six ambulatory individuals with unilateral, transtibial amputations. INTERVENTIONS: Subjects walked at 1.34 m/sec under three prosthetic limb loading conditions: (1) no added load; (2) loading that produced a match of prosthetic shank and foot mass and moment of inertia with those of the intact limb (100% load); and (3) a load that was half that of the 100% condition (50% load). MAIN OUTCOME MEASURES: Step length, swing time, stance time, and metabolic energy expenditure. RESULTS: As mass and moment of inertia of the prosthetic limb became more closely matched to the intact limb, step length, swing time, and stance time became less symmetrical. Energy cost for the 100% load condition was significantly greater (6% to 7%) than the baseline and 50% conditions. CONCLUSIONS: The loading configuration required to produce a match in the moments of inertia of the prosthetic and intact lower legs resulted in greater gait asymmetry and higher energy cost.

Adolescent↗
PubMed1996

Lower extremity amputation secondary to heparin-associated thrombocytopenia with thrombosis.

A rare cause of limb amputation is heparin-associated thrombocytopenia with thrombosis (HATT). There have been no case reports in the rehabilitation literature of lower extremity amputation secondary to HATT. Three case reports are presented to illustrate how HATT can develop and cause limb ischemia with subsequent amputation. HATT occurs in less than 1% of patients receiving heparin, has an immunological basis for its etiology, and is diagnosed both clinically and with laboratory confirmation. In addition, there are various treatment options, with the most fundamental being cessation of heparin therapy. HATT does present in the rehabilitation setting and physiatrists should be prepared to diagnose and manage it effectively.

Aged↗
PubMed1999

The Timed "up and go" test: reliability and validity in persons with unilateral lower limb amputation.

OBJECTIVE: To determine the interrater and intrarater reliability and the validity of the Timed "up and go" test as a measure for physical mobility in elderly patients with an amputation of the lower extremity. DESIGN: To test interrater reliability, the test was performed for two observers at different times of the same day in an alternating order. To test intrarater reliability, the patients performed the test for one observer on two consecutive visits with an interval of 2 weeks. To test validity, the results of the Timed "up and go" test were compared with the results on the Sickness Impact Profile, 68-item version (SIP68), and the Groningen Activity Restriction Scale (GARS). PATIENTS: Thirty-two patients, age 60 yrs or older, with unilateral transtibial or transfemoral amputation because of peripheral vascular disease. RESULTS: The Timed "up and go" test showed good intrarater and interrater reliability (r = .93 and .96, respectively). A moderate relationship exists between the Timed "up and go" test and the GARS, a good relationship exists with the "physical subscales" of the SIP68, and there is no relationship with the "mental subscales" of the SIP68. CONCLUSIONS: The Timed "up and go" test is a reliable instrument with adequate concurrent validity to measure the physical mobility of patients with an amputation of the lower extremity.

Activities of Daily Living↗
PubMed2000

Plastic changes and nitric oxide synthase induction in neurons which innervate the regenerated tail of the lizard Gekko gecko. II. The response of dorsal root ganglion cells to tail amputation and regeneration.

The lizard tail regenerates after amputation, which severs the spinal cord and spinal nerves. Dorsal root ganglia (DRGs) do not regenerate in the regrowing tail, which is innervated by DRGs rostral to the amputation. With Nissl staining, NADPH-diaphorase histochemistry and nitric oxide synthase (NOS) immunohistochemistry, we investigated NOS expression and its relationship with structural changes in DRG neurons of caudotomized lizards. First, by horseradish peroxidase retrograde tracing we here provided evidence that the sensory innervation of the regenerated tail derives only from the three pairs of DRGs rostral to the amputation plane. These ganglia were then analyzed in control animals with original intact tail, at 5, 15 and 30 days after caudotomy, and at 8 months in lizards with mature regenerates. Caudotomy elicited in DRG neurons marked hypertrophy that persisted after tail regeneration. In control ganglia, most neurons were lightly NADPH-diaphorase-positive, a few were unstained or intensely stained. Tail transection elicited marked staining up-regulation, and an increase in the proportion of intensely positive neurons. The staining intensity peaked in DRG neurons at 15 days and was still significantly increased in respect to controls several months after complete tail regeneration. NOS immunoreactivity in DRGs matched the histochemical findings. NADPH-diaphorase positivity was also enhanced in the dorsal horn superficial laminae of the corresponding spinal segments. We demonstrate that transection of the lizard spinal nerves, provoked by tail loss, elicits in the axotomized primary sensory neurons marked NOS enhancement, which accompanies axon elongation in the regrowing tail and persists after the end of this process.

Amputation, Surgical↗
PubMed1996

Temporary ectopic implantation for salvage of amputated digits.

Temporary ectopic implantation for salvage of amputated parts is a fascinating idea. The first successful case, to our knowledge, of preserving digits by means of temporary ectopic implantation to the contralateral forearm is presented and this treatment concept is discussed. The indication for temporary ectopic implantation is an amputation injury with associated extensive soft tissue damage in which immediate replantation with either adequate shortening or preservation of length does not seem feasible, although the amputated part itself is uninjured and should therefore be salvaged. The groin, axilla and lower arm are compared as possible recipient sites for ectopic implantation. Early replantation of the ectopic implanted parts will provide superior functional results although replantation may be technically more demanding. The function of a replanted extremity after ectopic implantation will probably always be inferior to a comparable, immediately replanted extremity.

Adult↗
PubMed2001

A case of forearm amputation after ovarian stimulation for in vitro fertilization-embryo transfer.

OBJECTIVE: To report a case of forearm amputation after ovarian stimulation for IVF-ET. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 41-year-old woman, who had coagulation disorder as a result of an ovarian hyperstimulation syndrome (OHSS) for IVF-ET. INTERVENTION(S): Retrospective evaluation of angiographic studies and surgical treatment. MAIN OUTCOME MEASURE(S): Medical follow-up after forearm amputation due to OHSS. RESULT(S): The patient underwent many cycles of IVF-ET with administration of purified FSH (75 IU 10 times per day, for 12 days) and chorionic gonadotropin (5,000 IU). The patient had a coagulation disorder as a result of OHSS, with thrombosis of the axillary vein, recurring after thromboarterectomy and leading to the paradoxical result of the amputation of an arm. CONCLUSION(S): An ethical evaluation of this case is mandatory, since the desire for pregnancy, the role of medical science, health, and human life itself are all factors involved.

Adult↗
PubMed1999

Amputated lower limbs as a bank of organs for other organ salvage.

Aggressive modern technologies have made it possible to attempt limb salvage in even the most extreme cases. However, it is imperative to remember that prolonged salvage attempts may lead to devastating complications. The decision-making is more problematic in patients with bilateral severely injured mangled lower limbs. In such a case, protocols like the MESS are no longer valid because of the implications of bilateral amputation. In these rare cases, we use a multi-team approach and modern micro-surgical reconstructive techniques in attempting to salvage at least one of the lower limbs. We present here our experience in six patients with bilateral mangled lower limbs where an amputated limb was the source of "spare parts" for the salvage of the contralateral limb. In each of the cases, after evaluation and planning, the harvesting of the required tissues (including skin, muscle, bone, nerve and blood vessels) from the amputated leg was performed and simultaneously, a reconstruction of the contralateral severely injured limb was done. These cases emphasize the importance of modern trauma care, not only the ability to treat multiply traumatized patients, but also the capability to execute sophisticated techniques during the acute phase of treatment with maximal cooperation between teams from different disciplines.

Adolescent↗