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At least 1,351 records · Page 75Linked to original sources
PubMed2000

Factors associated with ulceration and amputation in the neuropathic foot.

The purpose of this paper is to review selected literature on the relationship of neuropathy and other related factors in foot ulceration and lower extremity amputation. There is strong evidence that sensory loss and mechanical stress are the primary cause of foot ulceration and common factors in the pathway to lower extremity amputation. Foot stress results from extrinsic factors such as footwear and intrinsic factors such as deformity and limited joint mobility. Understanding the interplay of these factors is valuable in identifying persons whose feet are at risk, effectively preventing and treating foot ulcerations and ultimately preventing lower extremity amputation.

Amputation, Surgical↗
PubMed1990

Angiographic findings and need for amputation in high tension electrical injuries.

Because it is difficult to estimate the extent of deep tissue injury clinically, angiography was carried out in 28 patients with signs of damage from current flow through the body. Eight of the arteriograms showed normal extremities, 6 showed changes of small arteries, and 38 showed injury to the main arteries. In the latter group there were 24 total arterial occlusions, narrow irregular lumens in 10, and 4 had occlusion and distal refilling. Changes in the main arteries were most often seen near major joints where the internal body resistance as well as the density of the current are higher. Injury to the main arteries resulted in severe neuromuscular damage or amputation of the limb, whereas injury to small arteries resulted in little functional deficit. Of the 25 amputations 19 were at the level of the arterial occlusion. Spasmolytic drugs did not increase filling. We conclude that early angiography is valuable for the detection of deep injury and often indicates the level of adequate amputation or the need for immediate exploration. In some patients it indicates the necessity for arterial reconstruction.

Adolescent↗
PubMed1978

Prostheses for partial hand amputations.

Amputation of part of a hand may create significant functional limitations for the amputee which are difficult to ameliorate by either orthoses or prostheses. To help develop a logical approach to devices for partial hand amputations the patterns of losses have been studied and a division into four categories has been proposed. Transphalangeal, thumb spared; thenar, partial or complete; transmetacarpal, distal; transmetacarpal, proximal. By utilizing basic principles of orthotics and prosthetics and by exercising ingenuity, it is often possible to provide considerable improvement in function and/or cosmesis to individuals with partial hand amputations. Case illustrations and their prosthetic solutions are presented.

Adult↗
PubMed1980

Ischaemic wound complications in above-knee amputations in relation to the skin perfusion pressure.

Healing of the stumps in 59 above-knee amputations was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 131I-(-) or 125I-(-) antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no fewer than 9 (82 per cent) suffered wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only 4 cases (8 per cent). The difference in wound complication rate is highly significant (P < 0.01). It is concluded that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations.

Adult↗
PubMed1985

A rationale for skew flaps in below-knee amputation surgery.

The use of thermography in the assessment of amputation levels has demonstrated a medial to lateral thermal gradient in many cases. In order to see whether this reflected a true medial to lateral skin blood flow gradient, a prospective study was set up to measure blood flow medially and laterally below the knee. Twenty-one patients, presenting for amputation assessment with end-stage peripheral vascular disease, were studied. Skin blood flows were measured using an intradermal radioisotope clearance technique. Results showed a highly significant difference between medial and lateral skin blood flows (t = 4.79; p less than 0.001). In view of the significantly higher blood flow in the medial skin of the lower leg, it is suggested that a more medially based posterior below-knee amputation skin flap may be of more value in some patients.

Aged↗
PubMed1987

The influence of smoking on the level of lower limb amputation.

A review of smoking habits of 77 vascular related amputees demonstrated a high incidence of smoking significantly greater for men than in the general population. Male smoking amputees with atherosclerosis related peripheral vascular disease were found to have a high risk of having an above-knee amputation. Those with diabetes mellitus whether male or female, smokers or not, had a significantly greater chance of having a below-knee amputation. Overall, non-smokers were found more likely to have a below-knee amputation than an above-knee (p less than 0.05).

Aged↗
PubMed1990

An audit of amputation levels in patients referred for prosthetic rehabilitation.

Most lower limb amputations in the United Kingdom (UK) are carried out within general surgical, orthopaedic and plastic surgical units of district hospitals. This study of patients referred for rehabilitation was undertaken to determine the number and specialty interests of surgeons referring amputees, the numbers referred by each and, as one of several possible measures of appropriateness for rehabilitation, the amputation levels in patients referred for the first time to one sub-regional Disablement Services (limb fitting) Centre (DSC) over a 14 month period. Thirty nine surgeons, referred 263 amputees. The majority (61%) of surgeons referred 5 or fewer: a nucleus of 11 vascular surgeons (28%) referred 64% of the patients. The underlying pathology, specialty interest of the surgeon or numbers referred by individual surgeons had no relation to final healed level which was below the knee in 55% of cases compared to national figures for all other DSC's ranging between 39% and 48% below-knee between 1981 and 1988. Since current practice in the UK is to refer all but the frailest patients for consideration of prosthetic rehabilitation, this study suggests that, nationally, more patients could be suited for the functionally superior below-knee level of amputation than are currently benefiting from it.

Amputation, Surgical↗
PubMed1993

Gait patterns of elderly men with trans-tibial amputations.

Gait patterns for the non-amputated leg of eight elderly men with trans-tibial amputations were assessed using kinematic and kinetic measures. Kinematically, the subject's walking speed was faster than expected but less than normative non-amputee data. The stride length was also less than non-amputee norms. Net joint moment and power analyses showed various discrepancies between the amputee subjects and non-amputees. The amputees required a concentric ankle dorsiflexor moment just after heel-strike to help move the lower leg into mid-stance position. The concentric plantarflexor moment at push-off was much larger than comparative data. A large eccentric flexor moment was also found at the hip during late mid-stance. Most of these discrepancies could be explained by the lack of an ankle moment generator on the amputated side of the body.

Age Factors↗
PubMed1994

Amputation and reflex sympathetic dystrophy.

Reflex sympathetic dystrophy is a chronic pain syndrome characterized by chronic burning pain, restricted range of motion, oedema and vasolability. Patients are difficult to treat and the prognosis is very often poor. This report emphasizes that an amputation in case of a reflex sympathetic dystrophy is mostly due to a too late recognition of this syndrome. In the international literature little is written about an amputation as a therapy for reflex sympathetic dystrophy. It is only mentioned as a therapy in the end stages of this syndrome. Sometimes a rejected amputation, as in this case report, can have a relatively good result. An early recognition of this pain syndrome produces the best possible outcome.

Adult↗
PubMed1995

Amputation level assessment using lightguide spectrophotometry.

The aim of this experimental study was to investigate whether lightguide spectrophotometry in the visible wavelength range in skin could be used to predict stump healing viability in patients with critical lower limb ischaemia. Remission spectra recorded at two sites (medial and lateral) on the line of a proposed trans-tibial amputation (TTA) and at 10mm intervals along the leg were analysed to give haemoglobin oxygenation (SO2). Degree of tissue hypoxia (DTH) along the leg was defined as the percentage of values along the leg less than 10% SO2. DTH and mean SO2 values were compared with skin blood flow values ((I125) 4-Iodoantipyrine clearance technique) and clinical outcome of trans-tibial amputation, (TTA) or trans-femoral amputation (TFA), in 41 patients. SO2 histograms were also measured in 12 normal subjects for comparison. The results of the study allowed the establishment of criteria for the accurate prediction of flap healing potential. Successful TTAs all displayed a minimum mean SO2 at the medial and lateral measurement sites of 30%, together with a maximum degree of tissue hypoxia of 15% along the limb. The combination of these criteria gave a sensitivity and selectivity of 1.0 for prediction of a successful outcome of TTA.

Amputation, Surgical↗
PubMed1999

Prevalence and causal conditions for amputation surgery in the third world: ten years experience at Dodoma Regional Hospital, Tanzania.

This is a partly retrospective study of 252 major limb amputations carried out in regional hospital in Tanzania over a period of ten years mostly by the authors. The paper reports on the aetiology and levels of amputation and identifies prevalence and sex of the amputees. The causes of amputation classified under tumours, vascular diseases, trauma, infections, burns, animal bites, iatrogenic causes, maduromycosis and miscellanea--are discussed with particular reference to the influence of the environment, cultural habits and local customs.

Adolescent↗
PubMed1976

Muscle blood flow after amputation with special reference to the influence of osseous plugging of the medullary cavity. Assessed by 133 xenon and histamine. An animal experiment.

The muscle blood flow (MBF) in rabbits subjected to amputation of the crus was assessed by means of 133 Xenon and Histamine. It was shown that after the operation the flow in the amputation stump was initially reduced. MBF in the stump increased more rapidly and stayed at a higher level after closure by myoplasty than after amputation without myoplasty, and it was still further stimulated after osseous plugging of the medullary cavity.

Amputation Stumps↗
PubMed1979

Wound healing in above-knee amputations in relation to skin perfusion pressure.

In 59 above-knee amputations healing of the stumps was correlated with the local skin perfusion pressure (SPP) measured preoperatively as the external pressure required to stop isotope washout using 1318-- or 125I--antipyrine mixed with histamine. Out of the 11 cases with an SPP below 30 mmHg no less than nine (82 per cent) suffered severe wound complications. Out of the 48 cases with an SPP above 30 mmHg severe wound complications occurred in only four cases (8 per cent). The difference in wound complication rate is highly significant (P less than 0.01). The postoperative SPP measured on the stumps was on average only slightly and insignificantly higher than the preoperative values, explaining why the preoperative values related so closely to the postoperative clinical course. We conclude that the SPP can be used to predict ischaemic wound complications in above-knee amputations as has previously been shown to be the case in below-knee amputations.

Adult↗
PubMed1982

Standardized photoelectric technique as routine method for selection of amputation level.

During a period of 11 months 45 amputations, 31 below-knee and 14 above-knee, were performed in 42 patients with gangrene of the lower extremity. A newly introduced standardized photoelectric technique for measurement of local skin perfusion pressure (SPP) was used preoperatively and the result used in selection of the proper amputation level. An overall healing rate of 89 per cent was found. 69 per cent of the amputations were performed below-knee. The healing rates for individual SPP-levels were identical to those obtained with the cumbersome isotope washout technique. The standardized photoelectric technique is simple, rapid and causes the patient only negligible discomfort, allowing repeated measurements on different levels of the leg.

Adult↗
PubMed1983

Amputation for tumor of the upper arm.

In a 10-year period 35 patients underwent a proximal amputation of the upper limb because of a malignant tumor. In 27 patients a forequarter amputation was made, in one a humeroscapular disarticulation and in seven an amputation through the humerus. The observed 5-year survival was 23 per cent. Twelve out of 23 patients followed for at least 3 years also survived 3 years. Fifteen living patients were questioned concerning prosthetic use and social and psychologic factors. Only three patients used a functional (mechanical) prosthesis and only five used a cosmetic prosthesis. The other seven patients rejected the use of a prosthesis. Half of the patients had the same occupation postoperatively as preoperatively. Activities of daily living did not constitute any major problem. One of three housekeepers needed daily help. One patient seemed to have suffered obvious psychologic damage.

Adolescent↗
PubMed1989

Selection of lower limb amputation level not aided by transcutaneous pO2 measurements.

The transcutaneous oxygen pressure measurements were evaluated as supplementary ones for predicting stump healing in 58 below-the-knee and 16 above-the-knee amputations; the lower level was selected if the skin perfusion pressure was greater than 30 mm Hg below the knee. The failure rates in below-the-knee and above-the-knee amputations were 17 and 25 percent, respectively, and unrelated to the transcutaneous oxygen pressure measured at the amputation level. We conclude that no further information is acquired by measuring transcutaneous oxygen pressure.

Amputation, Surgical↗
PubMed1994

The social and economic consequences of finger amputations.

120 patients with amputation of at least 1 of the 4 ulnar fingers were admitted to hospital. In none was replantation considered to be possible because of serious damage to the soft tissues and bone. 12 (3-18) years after the accident 80 percent of the patients assessed their condition as good or fair, even those with proximal amputation or loss of 2 or 3 fingers. Our observations do not support replantation when only one of the second-to-fifth fingers have been amputated.

Adolescent↗