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PubMed1984

Amputations in diabetics and nondiabetics in Umeå county 1971-1977.

A consecutive series of 95 unselected patients submitted to amputation of the lower leg (59%) or at the thigh (41%) during 1971-1977 are the material of this retrospective study. Fifty-three were diabetic and 42 nondiabetic, the mean age was 77.2 and 73.1 years, respectively. There were no differences between diabetics and nondiabetics concerning age, lower leg/thigh amputations, postoperative healing, rehabilitation using prosthesis or subsequent amputation of the second leg.

Aged↗
PubMed1994

Spinal anaesthesia for patients with previous lower limb amputations.

Phantom limb pain has been reported as a transient phenomenon in patients with lower limb amputations during subsequent spinal anaesthesia. In order to determine its incidence and to define any predisposing factors we prospectively studied 23 spinal anaesthetics in 17 patients with previous lower limb amputation. Only one patient developed clinically significant phantom limb pain and we were unable to define any predisposing factors. Given the low incidence of recurrent phantom limb with spinal anaesthesia, its transient nature, and the fact that it can be treated if it occurs, we conclude that spinal anaesthesia is not contraindicated in patients with previous lower limb amputation.

Aged↗
PubMed2005

Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting.

BACKGROUND: Wounds with exposed bones caused by rheumatic diseases commonly result in amputation despite progress in our understanding of wound-healing mechanisms. OBJECTIVES: To determine whether an experimental therapy of bone marrow exposure, an occlusive dressing and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation in patients with rheumatic diseases. METHODS: Fifteen patients, including those with rheumatoid arthritis or systemic sclerosis, who had wounds with exposed bones were treated either with the standard procedure, consisting of local wound care, debridement with a scalpel, bed rest and parenteral antibiotics (n = 8), or with a newly developed experimental procedure (n = 7). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until bleeding was observed from the exposed bone. The lesions were immediately covered with an occlusive dressing, and were eventually treated with epidermal grafts obtained from suction blisters. RESULTS: A comparison with standard therapy demonstrated that the time needed for wound healing was similar, but that the newly developed combination therapy reduced the risk of amputation (P = 0.020). No skin ulcers or erosions were observed for at least 1 year in five of seven patients (72%) due to the adoption of stable palmoplantar-type characteristics in grafts derived from the trunk epidermis. CONCLUSIONS: Our study indicates that exposure of bone marrow cells plus an occlusive dressing accelerates the healing of skin ulcers at least partly through the preparation of a healthy well-granulated wound bed and that subsequent epidermal grafting achieves site-specific differentiation through epithelial-mesenchymal interactions.

Adult↗
PubMed1995

Reduction of gangrene and amputations in diabetic renal transplant patients: the role of a special foot clinic.

This 4-year prospective study investigated the reasons for high levels of gangrene and major amputation in diabetic renal transplant patients and whether regular multidisciplinary foot care could reduce morbidity. All foot lesions were documented and investigated in 50 diabetic patients, mean age 49.2 +/- 11.0 (SD) years, duration of diabetes 25.3 +/- 9.0 years, time since renal transplantation 60.2 +/- 35.1 months, who attended a special foot clinic monthly for education, vascular and neurological assessment, podiatry and footwear. Foot lesions included: neuropathic ulcers, ischaemic ulcers, traumatic lesions, Charcot's arthropathy, pathological fracture. Treatment included antibiotics, podiatry, footwear, and angioplasty or distal bypass where appropriate. Only 13 patients were deemed ischaemic but peripheral neuropathy was a very common finding (mean VPT 24.8 +/- 12.9 V). Gangrene and major amputations showed a decrease on previous years and healing times for lesions were similar to those previously reported in diabetic patients without renal transplants. The majority of foot lesions, both in soft tissue and bone, were related to neuropathy and trauma and responded well to optimal foot care within the renal unit. Gangrene and major amputations were usually preventable.

Ambulatory Care Facilities↗
PubMed1996

Squamous cell carcinoma arising in osteomyelitis and chronic wounds. Treatment with Mohs micrographic surgery vs amputation.

BACKGROUND: Squamous cell carcinoma (SCC) is a rare, but well-documented complication of osteomyelitis and chronic wounds. Treatment of choice for these tumors commonly occurring on the legs has been amputation. Two recent articles have suggested the utility of Mohs micrographic surgery (MMS) as a limb saving procedure. OBJECTIVE: To discuss the process of decision analysis in patients with SCC arising in osteomyelitis and chronic wounds. METHODS: Four patients with SCC (three developing in association with chronic osteomyelitis, one after a burn wound) are presented. RESULTS: Two patients underwent MMS as a limb-saving procedure, while the other two underwent amputation. Only two of our patients were able to have MMS since we were confronted with factors that precluded the use of this technique. These factors included the presence of metastatic disease and the potential for the loss of a functional limb after surgery. CONCLUSIONS: Our series confirms the utility of MMS as a potentially limb-saving procedure in patients with SCC arising in either chronic wounds or in association with osteomyelitis. Despite this, patients with distant spread of their disease or extensive local disease leading to the potential loss of functional stability of the leg postoperatively may not be candidates for MMS and may require amputation.

Aged↗
PubMed1986

Enlargement of rat submandibular salivary gland induced by single amputation of lower incisor teeth. Histological, histometric and ultrastructural studies.

Histological, histometric and ultrastructural studies of rat submandibular salivary glands (SMG) following single amputation of lower incisor teeth were made. The SMG enlargement occurred after the tooth amputation, and its maximal increase of weight was reached 7 days later. The results of histological and histometric observations showed that the enlargement of SMG was due to both hypertrophy and hyperplasia of the acinar cells, and hypertrophic acinar cells were ultrastructurally characterized by well-developed organelles such as rough-surfaced endoplasmic reticulum and Golgi apparatus which filled the entire cytoplasm. Hydropically swollen nerve endings with disappearance of vesicles were frequently found. In later stages, degenerative or necrotic cells were scattered in the acini, and the size and the structure of the remaining acinar cells became gradually similar to those of non-treated glands. The morphological changes seen in the enlarged SMG induced by single amputation of the lower incisor teeth in rat were similar in many ways to those of sialadenosis induced experimentally by active sympathomimetic drugs.

Amputation, Surgical↗
PubMed1991

Squamous cell carcinoma of the equine external genitalia: a review and assessment of penile amputation and urethrostomy as a surgical treatment.

A retrospective analysis was performed on 48 cases of suspected neoplasia involving the equine external genitalia. Forty nine squamous cell carcinomata (SCC) and 23 squamous papillomata (SP) were identified. Two cases of epithelial hyperplasia and one case of habronemiasis were also recognised histopathologically. The glans penis was the most common site of tumour development accounting for 53 per cent of cases of SCC and 61 per cent of SP. The urethral diverticulum, urethral process or urethra was involved in 27.6 per cent (8/29) of cases of SCC. Twelve per cent (5/41) of cases of SCC were confirmed to have metastatic involvement of the local lymph nodes. Papillomata showing pre-malignant changes were identified in five cases. Seventy five per cent (36/48) of the animals presented were ponies. All were geldings, mean age 16.5 years. Penile amputation and urethrostomy, preputial ablation and proximal urethrostomy or local excision were used in the surgical management of these animals; three cases were inoperable and destroyed at presentation. Oedema, haemorrhage and stenosis of the urethrostomy site were encountered as post operative complications. Sixty six per cent (6/9) of animals with SCC of the glans penis (without urethral involvement), which had a known history over the follow up period, treated by penile amputation and urethrostomy survived for longer than 18 months. Similarly, of those with urethral involvement only 28.6 per cent (2/7) survived for a similar follow-up period. SCC not uncommonly affects the external genitalia of aged pony geldings and frequently the glans penis. If the lesion is identified before local metastasis occurs, penile amputation and urethrostomy is indicated and the prognosis is favourable.

Amputation, Surgical↗
PubMed1978

Long-term effects of partial limb amputation in man.

Ten patients with amputation of part of one arm have been studied electrophysiologically. In each patient the ulnar nerve was stimulated electrically in the amputation stump and at a corresponding level in the intact limb. Control observations were also made on 15 normal subject. In the partially-amputated (PA) limbs the amplitudes of the centripetal ulnar nerve compound action potentials, after maximal stimulation of fast-conducting fibres, were markedly reduced in comparison with the results in control limbs. A small decrease in the mean impulse conduction velocity was observed in the population of PA limbs. In comparison with control observations, stimulation of the ulnar nerve in a PA limb evoked responses in the contralateral somatosensory cortex which were significantly diminished. Simulation of PA limbs caused reflex excitation and inhibition of triceps motoneurones similar to that observed in control subjects. In the intact limbs of the amputees, however, inhibition was reduced, possibly as a consequence of overuse. It is concluded that the receipt of an input from the periphery is essential for the functional integrity of most motor and sensory nerve axons, and probably for fibres in the dorsal column-medial lemniscus pathway.

Action Potentials↗
PubMed1984

Amputation stumps studied by bone scanning. Work in progress.

Nine diabetic and 7 nondiabetic (post-trauma) patients 24 to 63 years of age (mean, 49) were scanned following amputation below the knee, which was bilateral in 4. A three-phase scanning technique (flow, blood pool, and delayed equilibrium images) was employed, using Tc-99m-etidronate. Duration of the arterial and capillary phases was estimated during flow. Activity at the tip of the stump was plotted as a function of (a) time since amputation and (b) flow measurements. Activity was found to diminish over a period of nearly 50 months, usually becoming minimal or undetectable after 18 months. The stump demonstrated relative stasis compared to the intact limb, particularly in diabetics and patients with long-standing amputation.

Adult↗
PubMed1993

Angioplasty, bypass surgery, and amputation for lower extremity peripheral arterial disease in Maryland: a closer look.

Tunis and colleagues attempted to assess the effect of peripheral angioplasty in a large population with descriptive epidemiologic methods. Their study suffered from a vague statement of purpose, inappropriate and inadequate outcome measures, undetermined differences in prevalence of peripheral vascular disease and prevalence of risk factors for bypass/amputation in 1989 versus 1979, no differentiation between levels of amputation or between primary and secondary amputation, lack of a unique ICD-9-CM code indicating angioplasty for peripheral vascular disease of the lower extremities, lack of unique patient identifiers, a mistaken perception of the adoption of angioplasty as "widespread" in Maryland, and the assumption of uniform coding accuracy throughout the period of study. We conclude that the study design of Tunis et al was inadequate to determine the beneficial effects of angioplasty or bypass surgery in the treatment of peripheral vascular disease. Moreover, the conclusion by Coffman (2) that "invasive procedures are indicated only for the severely ischemic limb" is completely unsupported by the study data. Physicians should not attempt to apply the results of the study by Tunis et al to individual case situations. It should be further appreciated that the study findings do not provide an adequate basis for policy-making decisions. It is clear that important clinical questions concerning the roles of angioplasty, bypass, and amputation should be answered with more definitive studies.

Algorithms↗
PubMed2001

Intracortical pathway involving dysgranular cortex conveys hindlimb inputs to S-I forelimb-stump representation of neonatally amputated rats.

Reorganization of the primary somatosensory cortex (S-I) forelimb-stump representation of rats that sustained neonatal forelimb removal is characterized by the expression of hindlimb inputs that are revealed when cortical GABA receptors are pharmacologically blocked. Recent work has shown that the majority of these inputs are transmitted from the S-I hindlimb representation to the forelimb-stump field via an, as yet, unidentified pathway between these regions. In this study, we tested the possibility that hindlimb inputs to the S-I forelimb-stump representation of neonatally amputated rats are conveyed through an intracortical pathway between the S-I hindlimb and forelimb-stump representations that involves the intervening dysgranular cortex by transiently inactivating this area and evaluating the effect on hindlimb expression in the S-I forelimb-stump representation during GABA receptor blockade. Of 332 S-I forelimb-stump recording sites from six neonatally amputated rats, 68.3% expressed hindlimb inputs during GABA receptor blockade. Inactivation of dysgranular cortex with cobalt chloride (CoCl(2)) resulted in a significant decrease in the number of hindlimb responsive sites (9.5%, P < 0.001 vs. cortex during GABA receptor blockade before CoCl(2) treatment). Results were also compiled from S-I forelimb recording sites from three normal rats: 14.1% of 136 sites were responsive to the hindlimb during GABA receptor blockade, and all of these responses were abolished during inactivation of dysgranular cortex with CoCl(2) (P < 0.05). These results indicate that the S-I hindlimb representation transmits inputs to the forelimb-stump field of neonatally amputated rats through a polysynaptic intracortical pathway involving dysgranular cortex. Furthermore the findings from normal rats suggest that this pathway might reflect the amplification of a neuronal circuit normally present between the two representations.

Afferent Pathways↗
PubMed2006

[Methicillin resistant Staphylococcus aureus infection postoperatory complications and prognosis of patients with lower extremity amputations].

BACKGROUND AND OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increasing morbimortality when compared with other microorganisms. The aim of this study was to examine the complications and prognosis of the presence of MRSA in vascular patients with amputation of lower limbs. PATIENTS AND METHOD: We included patients who had lower extremity amputation in our department in 2004 and displayed positive surgical wounds cultures. We compared patients with MRSA positive cultures with other microrganisms. We evaluated general characteristics, operative indications, surgical wounds microbiology, reamputations, morbimortality and mean time of stay in hospital. RESULTS: 117 patients (median age 73, 68% male) underwent lower extremity amputation. 82 of them had positive cultures and MRSA were isolated in 30% cases. Two two groups were comparable and no statistical differences were found in relation to reamputation rate, morbimortality and mean time of stay in hospital. CONCLUSION: Presence of MRSA does not represent an additional risk of reamputation or an increase of postoperative complications. Careful wound surveillance, through wound debridement and optimal administration of antibiotics must be applied to all patients, regardless of the bacterial flora.

Aged↗
PubMed1984

Treatment of murine Wilms' tumor with chemotherapy after intramuscular tumor inoculation and amputation.

Wistar/Furth rats, implanted intramuscularly with Wilms' tumor, had the tumor removed by amputation 14 days after implantation. Chemotherapy with vincristine, actinomycin D and adriamycin was initiated after amputation as a single treatment and/or in combination. The survival of the chemotherapy-combination-treated animals was significantly increased. Recurrence of the tumor after amputation was also significantly decreased. The rate of metastases was significantly decreased from control groups. The combination therapy was more effective than single drug therapy.

Amputation, Surgical↗
PubMed1981

Amputation of the ischemic limb: selection of the optimum site by thermography.

This report describes the value of infrared thermography in assessing the optimum level of amputation of an ischemic limb. Interpretation of thermograms and the factors that can significantly alter the thermal image of the lower limbs are detailed. Results from 104 patients demonstrate that the thermographic method is a reliable indicator of the level of a major limb amputation. A rationale for the inadequacy of the method when attempting to determine the outcome of a partial foot amputation is considered.

Adult↗
PubMed1999

Prognostic aspects of TcPO2 in iloprost treatment as an alternative to amputation.

To help in determining management strategy as an alternative to amputation by using a synthetic prostacycline, a preliminary study was undertaken in 12 patients (11 men and one woman), with a mean age of 71.08 years, ie, 13 limbs evaluated at the stage of amputation. All patients were treated with a combination of iloprost and physical therapy (massage, specific exercises, cardiorespiratory training). Static transcutaneous oxygen pressure (TcPO2) was measured, with a sensitization test by verticalization and inhalation of oxygen, on day (D) D0, D15, D28, D60, D180, and D365. Results were analyzed in absolute terms and by tissue oxygenation ratio (TOR) (ratio between absolute values of TcPO2 in the foot and those of a reference chest electrode). Supine TOR and vertical TOR, with values of 36.67 and 65.08, respectively, appeared to be significantly linked to the variable "preservation of limb". At 1 year, seven limbs were preserved (53.85%) while amputation had been scheduled for all the patients treated. Evidence was found in all patients who kept their limb of stability (7.69%) and a decrease in (30.77%) or disappearance of pain (15.38%) at 1 year.

Aged↗
PubMedDate not supplied

Clinical experience with psychological aspects in pediatric patients amputated for malignancies.

AIMS AND BACKGROUND: Amputation surgery in pediatric patients suffering from malignant tumors is less common than in the past, but has a great emotional impact on patients and their families as well as on the medical team. Studies addressing the psychological aspects of limb amputation in childhood cancer are still relatively limited, and the results have sometimes been contradictory. METHODS: At the Pediatric Oncology Unit of the Istituto Nazionale Tumori of Milan psychological support was provided to candidates for amputation and their families, involving medical oncologists, a clinical psychologist, and social assistants. Twenty-two patients were analyzed and 16 underwent mutilating surgery. RESULTS: Different emotional reactions were observed. Surgery proved to be easier to accept when the tumor caused pain and functional loss. Specialist medical psychological support was needed in case of defense mechanisms (eg, splitting and projection) and depressive reactions evolving into isolation or intolerance. CONCLUSIONS: The reported experience could be helpful in providing adequate support to children with tumors requiring mutilating surgery.

Adaptation, Psychological↗
PubMedDate not supplied

Thumb amputations from team roping.

BACKGROUND: Thumb injuries during team roping have elements of both avulsion and crush, resulting in a poor prognosis for replantation success. PURPOSE: To review 19 cases of thumb amputation from team roping at our institution since 1983. STUDY DESIGN: Retrospective cohort study. METHODS: Cases were included in the study only if a microvascular repair of artery and vein was needed for the thumb to survive. Vein grafts were used to span the damaged vessel segment. Of the 19 thumb amputation cases, 15 attempts were made to replant the thumb. In the remaining four cases, patients had bone shortening and primary closure. The force of injury was calculated based on mechanism. RESULTS: Of the 15 attempts at replantation, only 5 (33%) were successful, despite meticulous technique. One patient subsequently had an emergency toe-to-thumb transfer after an unsuccessful replant, and the remaining nine underwent amputation. Nine of the 10 patients with failed replants had poor flow intraoperatively. In the group of patients younger than 15, the success was 3 of 5 (60%) and in the group 15 years or older the success was 2 of 10 attempts (20%.) Follow-up was available in 13 of the 15 cases of replanted thumbs. CONCLUSIONS: All patients were subjectively satisfied with their results, and all patients with successful replants and seven patients with no thumb returned to rodeo. Biomechanical analysis showed a huge amount of force and pressure, several times larger than that of ring avulsion injury, results when a steer pulls on the thumb.

Adolescent↗
PubMed2005

Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study.

BACKGROUND: Diabetic foot ulcers, foot infection, Charcot foot arthropathy, and lower extremity amputation have a severe negative effect on the health-related quality of life in individuals with diabetes. The purpose of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression. METHODS: Sixty adults with diabetes completed the Short Form 36 (SF-36) Health Survey questionnaire, two screening examinations for cognitive function (Mini Mental Exam and Clock-Drawing Test), and a screening examination for depression (Zung Self-Rating Depression Scale). The two focus groups were composed of 20 subjects each who were undergoing treatment for (1) diabetic foot ulcers or active Charcot foot arthropathy or (2) lower extremity amputation. Twenty diabetic individuals without foot-related morbidity but with evidence of peripheral neuropathy as measured by insensitivity to the Semmes-Weinstein 5.07 (10 gm) monofilament comprised the control group. RESULTS: The SF-36 Health Survey score was significantly impaired in both the diabetic foot ulcer and Charcot arthropathy group (p <0.001) and amputee (p <0.000) group. There was no evidence of cognitive impairment or depression in either group. The negative impact on health-related quality of life was similar in both focus groups (p <0.314). CONCLUSION: The results of this preliminary study suggest that the negative impact on health-related quality of life in diabetic patients with foot ulcers or Charcot foot arthropathy may be as severe as in similar patients with lower extremity amputation. The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group.

Adult↗