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At least 1,243 records · Page 69Linked to original sources
PubMed2003

In utero limb salvage: fetoscopic release of amniotic bands for threatened limb amputation.

The natural history of extremity amniotic band syndrome (ABS) is a progression to deformity or amputation. Fetoscopic laser release of amniotic bands in extremity ABS offers the potential to prevent limb amputation. The authors report on 2 patients with isolated extremity ABS who underwent fetoscopic release. Both patients had isolated extremity ABS with compromised extremity perfusion and no other significant structural abnormality diagnosed sonographically. The first patient underwent fetoscopic release of bands of the left wrist, and the second patient underwent lysis of bands around the right wrist and an unsuspected band around the right lower extremity. Both patients had restoration of blood flow by color Doppler to the affected extremity. There were no perioperative complications. In select patients with isolated extremity ABS, early fetoscopic release may prevent amputation and allow improved limb development.

Adult↗
PubMed1997

Toe amputation in the diabetic patient.

BACKGROUND: We considered whether it is more practical to amputate the toe of a diabetic patient with osteomyelitis and good circulation or to treat the patient with antibiotics for a prolonged period. METHODS: We undertook a retrospective study of 141 diabetic patients who had undergone a toe-ray amputation for proven or documented osteomyelitis. RESULTS: The mean ankle/brachial index of all patients was 0.81 (range, 0.68 to 1.14); the mean functional days lost on antibiotic therapy was 39 (range, 7 to 84 days). The cost of 6 to 8 weeks of preoperative antibiotic therapy was $900 to $2240 (mean, $1440). CONCLUSIONS: Diabetic patients with good circulation and osteomyelitis of the toe may benefit from prompt toe amputation.

Amputation, Surgical↗
PubMed1987

Fate of the vascular patient after below-knee amputation.

50 below-knee amputations were carried out in 45 patients (25 men and 20 women), mean (SD) age 73 (10.5) years. The mean survival time was 22(16) months after the operation. In each patient the healing potential of a below-knee amputation was determined preoperatively by segmental pressure studies and thermographic delineation of skin perfusion. 33 of the stumps healed by first intention, in 14 healing was delayed but occurred without the need for further surgery, and 3 stumps healed after local wedge excision. The initial mobilisation rate was 90%. Thus, there are no grounds for carrying out an initial above-knee amputation to save the patient a further operation.

Aged↗
PubMed1997

Subcutaneous T-cell lymphoma treated with systemic chemotherapy, autologous stem cell support, and limb amputation.

Subcutaneous T-cell lymphoma is an unusual variant of peripheral T-cell lymphoma in which the malignant infiltrate preferentially involves the subcutis. The disease is often initially misdiagnosed as a benign inflammatory panniculitis or a granulomatous disease. We describe subcutaneous T-cell lymphoma in a 39-year-old man who was treated with systemic chemotherapy, autologous stem cell support, and amputation of the limb primarily involved with the lymphomatous infiltrate. This is the first report of amputation being included in the treatment regimen of subcutaneous T-cell lymphoma. Because preferential involvement of the extremities often occurs in patients with subcutaneous T-cell lymphoma, surgical debulking of refractory disease by partial or complete limb amputation may be a useful therapeutic adjunct.

Adult↗
PubMed1996

Replantation-revascularization and primary amputation in major hand injuries. Resources spent on treatment and the indirect costs of sick leave in Sweden.

Thirty consecutive patients with amputation or devascularizing injuries of the thumb or two or more fingers proximal to the PIP joint were reviewed. Replantation or revascularization had been done in 27 patients, in 24 successfully. Three patients had primary amputation. The distribution of calculable costs was dominated by those for sick leave (49%), operation (26%) and ward costs (20%). Out-patient care, physiotherapy and travel together constituted only 6%. The cost of a successful replantation was equal to 1.6 times the mean annual salary of these patients and that of primary amputation about half as much. Mobility, power and performance of a standardized grip test were better for the successfully replanted or revascularized patients. Subjective evaluation of 23 parameters of function, cosmesis and quality of life did not disclose any differences. All patients except three had returned to their original work within 2 years.

Adolescent↗
PubMed2003

Reorganization in the ipsilateral motor cortex of patients with lower limb amputation.

The aim of the present study was to assess reorganization in the motor cortex of patients with lower limb amputation. We studied seven patients with traumatic lower limb amputation, and six healthy controls, using transcranial magnetic stimulation mapping, with recordings from the quadriceps femoris muscle on both sides. Motor threshold, sum of amplitudes, area and the amplitude-weighted centre of gravity (COG) of the motor output map were assessed. We found a significant lateral displacement of the COG on the hemisphere contralateral to the healthy leg, whereas other parameters did not differ significantly between sides. This finding might be indicative of cortical reorganization in the hemisphere ipsilateral to the amputation. It is discussed with respect to an altered peripheral input to this hemisphere, and to transcallosal interactions from the deafferented hemisphere.

Adaptation, Physiological↗
PubMed2001

Pain site and the effects of amputation pain: further clarification of the meaning of mild, moderate, and severe pain.

Research among persons with cancer pain suggests that the association between pain intensity and pain interference is non-linear. That is, pain begins to have a serious impact on functioning when it reaches a certain threshold level (about 5 on 0--10 scales). Often, a second pain threshold can be identified which, once reached, shows an even greater proportional negative impact on functioning. This finding supports the potential clinical utility of classifying pain as mild, moderate, and severe based on the impact of pain on quality of life, and research among persons with cancer pain supports specific cutoffs (mild: 1--4, moderate: 5--6, severe: 7--10, see Pain 61 (1995) 277) for this classification. The current study sought to replicate the non-linear association between pain and pain interference in a non-cancer pain sample, determine whether the cutoffs that have been identified as optimal for cancer patients are also optimal for persons with pain associated with amputation, and determine whether the optimal cutoffs replicate across pain types (in this case, phantom limb, back, and general pain) within a single sample. Two-hundred and five persons with acquired amputation and phantom limb pain, back pain, or both, rated their average pain intensity and degree of pain interference for each type of pain. The results support a non-linear association between pain intensity and pain interference. However, the optimal cutoffs for classifying mild, moderate and severe pain in the present sample replicated the findings for persons with cancer pain only for back pain -- different optimal cutoffs were found for phantom limb and general pain. Moreover, the degree of pain interference appeared to vary as a function of pain type. The same level of back pain interfered more significantly with daily function than phantom limb pain did after pain levels reached five or more (on a 0--10 scale). These findings have implications for understanding the meaning of pain intensity levels, as well as for the assessment of pain intensity in persons with amputation-related pain.

Adult↗
PubMed1980

Immediate pollicization of an amputated index finger.

A case of immediate pollicization of an amputated index finger is reported. The patient sustained accidental amputation of the entire thumb and index finger and subtotal amputation of the middle finger of her left hand. Two years following replantation of the index finger to the thumb position, the finger has limited motion but the patient has a functional replanted digit.

Amputation, Traumatic↗
PubMed1983

Selective finger transposition and primary metacarpal ray resection in multidigit amputations of the hand.

In multidigit amputations parts with the most favorable prognosis (cleaner amputation, less crushed, short ischemia time) can be "selectively" replanted in positions most appropriate to providing useful function and cosmetic acceptability, regardless of their anatomic origin. Digits with poor prognosis are not reattached. These principles are applied in four selected cases involving multidigit amputations proximal to the proximal interphalangeal joints in which the least traumatized digits were selectively joined to the more ulnar metacarpal rays; intervening metacarpal shafts were primarily resected to clear the first web space of obstructing bony stumps. The narrowed palmar arch, although weaker, achieves wider palmar span grasp. Fingers in contiguity, although fewer in number, allow improved precision handling, chuck pinch, and cosmetic acceptability.

Adult↗
PubMed1985

Profundus tendon blockage: quadriga in finger amputations.

After finger amputations, spontaneous adhesions of the resected profundus tendon may occur in the finger stump or palm. Because of the normal interconnections of the profundus tendons, such adhesions can block the excursion of the profundus tendons to intact fingers, resulting in the quadriga syndrome, or profundus tendon blockage. This causes a decrease in the power and range of movement of the terminal joints of the uninjured fingers when they are fully flexed. Three degrees of severity of this weakness are described. The findings and results of surgery in 20 patients demonstrate that the condition is surgically correctable by release of the adherent profundus tendon of the amputated digit. Full active flexion and extension of the intact fingers in the early postoperative period after primary amputation should prevent them from developing profundus tendon blockage.

Adult↗
PubMed1999

Vascular reconstruction utilizing artery from an amputated extremity: A case report.

Although infrainguinal arterial reconstruction is best performed with autologous tissue, reconstruction with vein in an infected field has been associated with vein graft disruption and hemorrhage. H.P., a 61-year-old man with peripheral vascular disease, was initially seen with an infected prosthetic right femoral-tibioperoneal artery bypass graft. Because of the presence of purulent drainage from the proximal and distal anastomotic regions and his comorbidities, a right through-knee guillotine amputation was performed, followed by graft excision and groin débridement. Right hip and thigh perfusion was preserved via arterial reconstruction by using a segment of endarterectomized popliteal artery, harvested from the amputated extremity. Arterial reconstruction with autologous tissue from an amputated extremity allowed us to balance our patient's overall risks with life and tissue preservation. This technique may be applied in the settings of lower extremity ischemia, trauma, or malignancy requiring concomitant arterial or venous reconstruction.

Amputation, Surgical↗
PubMed1995

Arterial emboli of the lower limbs: analysis of risk factors for mortality and amputation. Association Universitaire de Recherche en Chirurgie.

To evaluate risk factors for mortality and amputation after arterial embolism of the lower limbs, we reviewed the records of 397 patients (201 men [mean age 69 +/- 14 years] and 196 women [mean age 79 +/- 12 years]) who were enrolled in a prospective study. The degree of ischemia was rated as follows: grade I in 26% of patients, grade II in 46%, and grade III in 27%. Among patients with complete obstruction, the emboli were located above the inguinal ligament in 213 limbs (46%), in the superficial or popliteal artery in 196 (43%), and at the infrapopliteal level in four (3%). The emboli were bilateral in 59 cases (15%). In 11% of patients the emboli also involved either an upper limb or a visceral or cerebral artery. The origin of the embolus was the heart in 55% of patients, an artery in 12%, and was unknown in the remaining cases. Two hundred two patients (50%) had arterial fibrillation, 33 (8%) had cardiac conduction abnormalities, 186 (47%) had ischemic heart disease, 55 (14%) had valvular heart disease, and 43 (11%) had cardiac insufficiency. The in-hospital mortality rate was 15% (n = 60) and major amputations or severe ischemic sequelae were observed in 23% (n = 91). Logistic regression analysis revealed four independent preoperative factors associated with a significantly higher risk of death: associated visceral emboli with a relative risk (RR) of 6.7 (p < 0.001), invalidism with an RR of 4.3 (p < 0.001), cardiac insufficiency with an RR of 2.4 (p = 0.001), and creatinemia > 180 ml/L with an RR of 2.1 (p = 0.01). The variables associated with an increased risk of amputation were invalidism (p = 0.001), severity of ischemia (p = 0.001), infrapopliteal location of the embolus (p = 0.001), delay of more than 12 hours before treatment of severe ischemia was initiated (p = 0.01), failure to restore arterial patency (p = 0.001), and postoperative cardiac complications (p = 0.01).

Aged↗
PubMed2000

Anaesthesia and analgesia for major lower limb amputation.

This study describes the methods of anaesthesia and analgesia used in 349 major lower limb amputations for vascular disease over a seven year period (1992-8). The main type of anaesthesia was general in 55%, spinal in 29%, and epidural in 14%: there were no significant differences for ASA grade, age, or amputation level, nor any statistical differences in mortality for each method of anaesthesia. The main methods of analgesia in the first 48 hours changed between 1992 and 1998, with decreasing intramuscular and oral opioids (from 38% to 7%, and from 23% to 2% respectively) while epidurals became the commonest method (4% in 1992 and 63% in 1998). Thirty seven percent of patients were prescribed carbamazepine for phantom pain. There have been substantial changes in postoperative analgesia following amputation, and epidurals are now common practice, despite the controversy about their role in preventing phantom pain.

Adult↗
PubMed1997

Cumulative risk of bypass, amputation or death following percutaneous transluminal angioplasty.

OBJECTIVE: To define cumulative risk of reconstruction, amputation or death following percutaneous transluminal angioplasty (PTA). DESIGN: Non-randomised observational study. PATIENTS AND METHODS: Two hundred and thirty-four PTAs in 212 patients. Minimum follow-up 6 months. Examination of data collected prospectively on manual card index. Examination of radiology and theatre ledgers over 2.5-year period. District Information System (Dis Data). Life-table analysis. RESULTS: The cumulative risks of reconstruction at 12 months were 14.9% and 6.7%, respectively, following angioplasties below and above the inguinal ligament. Major and minor amputations were more common if the original lesions were below the inguinal ligament (relative risk (RR) 3.32, confidence interval (CI) CI 0.42-26.26 and RR 4.24, CI 0.055-32.9, respectively). They were also more likely in diabetic compared with non-diabetic patients (RR 9.95, CI 2.85-34.47 and RR 3.66, CI 1.28-10.44, respectively). No patient who presented with claudication underwent amputation. Death was more common in patients originally presenting with rest pain or gangrene than claudication (RR 3.94, CI 1.51-10.31). CONCLUSION: This study confirms the poor outlook of diabetic patients with peripheral vascular disease or those presenting with rest pain, ulceration or gangrene. Percutaneous transluminal angioplasty was associated with approximately 80% limb salvage rate in those patients during the duration of the study.

Adult↗
PubMed1980

Illness and amputation in the eighteenth century: the case of Sir James Lowther (1673-1755).

Sir james Lowther of Whitehaven (1673-1755) suffered from gout, and eventually had his right leg amputated in 1750. He also experienced other serious illnesses. Surviving correspondence between Lowther, in London, and his Whitehaven steward, contain graphic accounts of his health, particularly the serious illness and amputation of 1750. From these letters, and a document surviving in the British Museum describing an attack of erysipelis in 1742, a short, documentary account of Lowther's medical history has been compiled. If for no other reason, he deserves to be remembered for surviving an amputation without anaesthetic, at the age of seventy-seven.

Amputation, Surgical↗
PubMed1978

Effects of amputation and Corynebacterium parvum on tumour metastases in mice.

The effects of operation (lower-limb amputation) on the growth of the Lewis lung tumour and its metastases were studied. The role of C. parvum in counteracting these effects was investigated. Anaesthesia alone or with amputation did not affect primary tumour growth. C. parvum depressed this growth. Anaesthesia did not affect the number of pulmonary metastases, but amputation caused a significant increase. C. parvum inhibited metastases and completely counteracted the effects of operation on them. Large doses of cortisone acetate significantly increased metastases but small doses had no effect. Experiments with adrenalectomized mice suggested the effects of operation were due to non-specific stress.

Adrenalectomy↗
PubMed2000

Graftskin heals an ulcer on an amputation stump.

BACKGROUND: A 51-year-old man presented with a chronic ulcer of 28 years' duration on the amputation stump of his right foot. The prosthesis was aggravating the ulcer, despite multiple therapies. OBJECTIVE: To heal the ulcer and avoid a below-the-knee amputation. Graftskin, a bilayered living skin construct, was applied. METHODS: Graftskin was sutured in place following gentle debridement. Pentoxifylline was given to improve circulation. The dressing was changed 5 days after Graftskin application, then weekly for 7 weeks. RESULTS: Crusting was evident at 3 weeks, with an underlying white coating at 4 weeks. By 7 weeks, full reepithelialization was present under the crust and no ulceration remained. Over succeeding weeks the ulcer bed became flush with the surrounding skin. The patient's pain ceased, and some sensation and warmth returned to the stump. CONCLUSION: Graftskin treatment successfully healed a chronic ulcer, possibly preventing a more extensive amputation.

Amputation Stumps↗
PubMedDate not supplied

Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas.

Nine patients divided into two groups were treated for pedunculated supernumerary digits or their sequelae. The first group consisted of three patients who had among them five traumatic amputation neuromas. In each case these lesions resulted from primary suture ligation of accessory digits in infancy. Secondary surgical excision of the vestigial digit with high ligation and retraction of the accompanying nerve tissue was required in all cases. The second group consisted of six patients who had 12 pedunculated supernumerary digits. Primary surgical excision of these digits was performed with high transection and retraction of the accompanying accessory digital nerve. All patients in this group had excellent cosmetic results with no postoperative neuroma formation. Adult family members who had undergone suture ligation of similar supernumerary digits in infancy accompanied seven of the nine patients in this series. On careful examination, each of these family members had signs and symptoms attributable to traumatic amputation neuromas. We feel identification and high transection of the accessory digital nerve is essential in the treatment of pedunculated supernumerary digits. This treatment prevents traumatic amputation neuromas and yields a better cosmetic result than the traditional method of suture ligation in infancy.

Adolescent↗