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PubMed1992

Finger amputations in Tanzania.

A survey of finger amputations carried out at Dodoma Regional Hospital, has shown that from 1983 to 1991, a total of 147 amputations have been done on 101 patients. They have been performed, mostly for causes that relate quite well with the living and working conditions of the inhabitants of Dodoma Region. Western causes of finger amputations have been responsible of ablation in a few patients in our series. Finger infection, usually with bone involvement, has been found to be the leading cause, followed by traumatic injuries, human bites and burns. Most patients were peasants, with a good number of illiterates among them, drawn from rural areas. They came late to hospital having been improperly managed in the early stages of the diseases. All these factors explain quite well why finger infections were, on admission, irrecoverable through medical means.

Adult↗
PubMedDate not supplied

[The patient undergoing amputation of the lower limbs and the changes in activities of daily living].

The present study is part of the DIOGO monograph. The objective is to verify the alterations identified in aged patients which had been submitted to amputation of their lower limbs, in relation to everyday life. The data was collected from 25 inpatients, of a government university hospital. The analysis of the results suggests that the alterations referred by the patients submitted to amputation less than 10 days before coincide with those referred by aged patients which had had their limbs amputated over a month before, in the items related to body hygiene and locomotion.

Activities of Daily Living↗
PubMed1992

Improved preservation of skeletal muscle in amputated limbs using pulsatile hypothermic perfusion with University of Wisconsin solution. A preliminary study.

To determine whether pulsatile hypothermic perfusion with University of Wisconsin preservation solution is superior to topical cooling as a method for the preservation of amputated limbs, six pairs of amputated canine limbs were preserved for twelve to fifteen hours. One limb of each pair was subjected to topical cooling and the other, to pulsatile hypothermic perfusion with University of Wisconsin solution. The bioenergetic status of the limbs was monitored by 31phosphorus magnetic-resonance spectroscopy, and histological evaluation was performed to assess ischemic changes in the preserved tissue. The pH and tissue levels of adenosine triphosphate declined three times more slowly in the limbs that were preserved by pulsatile hypothermic perfusion than in the topically cooled limbs. Consistent with these findings, the perfused limbs also had less histological evidence of ischemic injury. The data from this in vitro study show that pulsatile hypothermic perfusion with University of Wisconsin solution, in combination with an optimum degree of topical cooling, is superior to topical cooling alone as a method of preserving the bioenergetic status of amputated limbs.

Adenosine↗
PubMedDate not supplied

[Reconstructive surgery of the thumb after traumatic amputation (author's transl)].

The authors analysed the results of two series of patients treated either by lengthening (16 cases) or digital pollicization (45 cases). The conclusions about the indications for the two techniques are as follows: When the amputation is proximal and the sole lesion, pollicization of the ring finger is preferred. In distal amputations in children, pollicization is still indicated, but in adults, lengthening, with a pedicle island-flap to give sensation is preferable. In amputations of the thumb associated with lesions of other digits, pollicization is not feasible; in these cases, the authors recommend a toe transplant using micro-surgical technique.

Adolescent↗
PubMed2004

[Fingertip replantation after amputation: report of 32 fingers].

OBJECTIVE: To describe the surgical techniques and our experiences in fingertip replantation after amputation. METHODS: On the basis of examination of the anatomic features and the degree of fingertip vascular injury, 32 amputated fingertips in 26 cases were replanted, and flexible revascularization procedures of both artery and vein anastomoses, artery-only anastomosis, arterialized vein and arteriovenous anastomosis were adopted. All the replanted fingertips were trained with comprehensive rehabilitation program. RESULTS: Twenty-nine replanted fingertips survived but 3 failed, and the overall survival rate was 90.06%. During the follow-up lasting from 4 months to 5 years, the 29 replanted fingertips survived with excellent blood supply, good sensory functions, satisfactory shape and functions according to the criteria by Society of Hand Surgery of Chinese Medical Association. CONCLUSIONS: Fingertip replantation after amputation can achieve not only high survival rate but also satisfactory appearance and functions as long as appropriate operative procedures are adopted with comprehensive rehabilitation therapy.

Adolescent↗
PubMed1992

Predictive value of transcutaneous oxygen pressure and amputation success by use of supine and elevation measurements.

The purpose of this study was to determine if transcutaneous oxygen pressure (tcPO2) measurements can be used to predict amputation site healing in lower limbs with arterial occlusive disease. We measured tcPO2 (supine and with limb elevation) in 90 limbs before amputation and reviewed their subsequent clinical course. Of these, 52 (57%) successfully healed, 21 (23%) failed, and 17 (18%) exhibited delayed healing. Limbs with delayed healing or failure had significantly lower tcPO2 values than values of those that healed. A tcPO2 greater than or equal to 40 torr was associated with primary or delayed healing in 51 of 52 limbs (98%), and a tcPO2 value of less than 20 torr was universally associated with failure. For patients with a tcPO2 between 20 and 40 torr, tcPO2 measurements obtained during limb elevation improved the predictability of outcome. We conclude that supine tcPO2 measurements can help predict amputation site healing, and that tcPO2 measurement during limb elevation improves predictability in limbs with borderline supine tcPO2 values.

Adult↗
PubMed1992

[Inter-nosocomial variations in amputations for vascular insufficiency].

A study has been made of 18,225 admissions to Danish hospitals for lower limb amputation in cases of diabetic or non-diabetic vascular insufficiency. Clear correlations were found between the type of department and the level of amputation, mortality and duration of hospitalisation, orthopaedic departments being characterized by lower levels of amputation, lower mortality, and shorter hospitalisation than general surgery or mixed departments.

Aged↗
PubMed2004

[Famous cases for amputation].

After a short historical survey 14 cases of celebrated personalities one woman and 13 men, with the grave handicap of amputation are represented. The causes of the lost limbs, once of the nose, were battle injuries (guns) or accidents. In many cases the protheseology followed the amputation, dependent on the technological level of the day. Often medical providing was bad and terrible. The introduction of anaesthesia changed the amputation technique. During different periods from renaissance to the first half of the twentieth century remarkable fates happened. Heroes as the emperor Friedrich III., the knight Goetz von Berlichingen, well known by the spectacle of Goethe, the scientist Tycho Brahe, the merchant and skipper Peter Stuyvesant, the military men Duke Christian II. of Braunschweig-Lueneburg-Wolfenbuettel, William Bayly, Admiral Lord Nelson and Earl Claus Stauffenberg, the actress Sarah Bernhard, the squadron leader of RAF Douglas R. S. Bader and other gave an excellent example for fulfilled life despite handicap. With their artificial legs, arms or hands they rode, fought, shoot, made sports etc.

Amputation, Surgical↗
PubMed2005

The L test of functional mobility: measurement properties of a modified version of the timed "up & go" test designed for people with lower-limb amputations.

BACKGROUND AND PURPOSE: Walk tests provide essential outcome information when assessing ambulation of individuals with lower-limb amputation and a prosthetic device. Existing tests have limitations such as ceiling effects or insufficient challenge. The objective of this study was to assess the reliability and validity of data for a clinical measure of basic mobility, the L Test of Functional Mobility (L Test). SUBJECTS: For this methodological study, 93 people with unilateral amputations (74% transtibial, 26% transfemoral; 78% male, 22% female; mean age=55.9 years) were consecutively recruited from an outpatient clinic. Twenty-seven subjects returned for retesting. METHODS: To assess concurrent validity, subjects completed the L Test, Timed "Up & Go" Test (TUG), 10-Meter Walk Test, and 2-Minute Walk Test, followed by the Activities-specific Balance Confidence scale, Frenchay Activities Index (FAI), and mobility subscale of the Prosthetic Evaluation Questionnaire (PEQ-MS). Amputation cause and level, walking aid use, automatic stepping, and age variables were used to assess discriminant validity. RESULTS: Intraclass correlation coefficients were .96 for interrater reliability and .97 for intrarater reliability, and minimal bias existed upon retesting. The magnitude of concurrent validity correlations (r) was very high between the L Test data and data for other walk tests and fair to moderate between the L Test data and data for self-report measures. The L Test discriminated between all groups as hypothesized. DISCUSSION AND CONCLUSION: The L Test is a 20-m test of basic mobility skills that includes 2 transfers and 4 turns. It demonstrated excellent measurement properties in this study.

Adult↗
PubMed1992

[Morphologic and morphometric study of the superficial peroneal nerve. Use of material from autopsies and amputations].

A series of 100 human peroneal nerves proceeding from autopsies and amputations were studied by histologic and morphometric techniques with a qualitative and quantitative analysis of each being performed following the morphological criteria of Dick et al (1985). After evaluating the results the authors consider that the peripheral nerve proceeding from autopsies and amputations is useful for basic morphologic study providing it is adequately processed within the first 29 hours post-mortem and post-amputation. Previous studies demonstrating the existence of minimum morphological alterations in normal nerves is corroborated. In order to perform a correct morphological evaluation of the peripheral nerve a mere qualitative analysis is not sufficient but rather statistically evaluated quantitative parameters must be employed.

Aged↗
PubMed2005

[Short-term results of "large" amputations in patients with chronic lower limb arterial occlusions].

The results of examinations and treatment are presented for 238 patients with lower limb arterial occlusions after "large" amputation for critical limb ischemia. Arterial reconstructions and lumbar sympathectomy, adequate choice of amputation level based on objective parameters of macro- and microcirculation, epidural anesthesia, prophylaxis of early thromboembolism and cardiovascular complications are measures which can improve results of "large" amputations in patients with lower limb arterial occlusions.

Adult↗
PubMed1992

Treatment of dogs with osteosarcoma by administration of cisplatin after amputation or limb-sparing surgery: 22 cases (1987-1990).

Twenty-two dogs with appendicular osteosarcoma were treated by amputation (n = 17) or limb-sparing surgery (n = 5). All dogs were given cisplatin (60 mg/m2 of body surface, IV) at 3-week intervals, beginning 1 week after surgery. Number of cisplatin treatments ranged from 1 to 6. Survival data for the 22 dogs were compared with survival data from a historical control group consisting of 162 dogs with appendicular osteosarcoma treated by amputation alone. Median survival time for the 22 dogs given cisplatin was estimated to be 46.4 weeks, and 1- and 2-year survival rates were estimated to be 45.5 and 20.9%, respectively. Survival time was significantly (P less than 0.0001) longer for treated dogs than for control dogs. Statistically significant relation was not found between survival time and number of cisplatin treatments. Three dogs were alive with no evidence of disease at the time of reporting. Of the remaining 19 dogs, 14 (73.4%) were euthanatized for problems documented to be related to metastases. Nine (47.4%) dogs were euthanatized because of bone metastases, and 5 (26.3%) were euthanatized because of pulmonary metastases. The proportion of dogs euthanatized because of bone metastases was significantly (P less than 0.0001) higher for treated than for control dogs. Median survival times for dogs developing bone and lung metastases were estimated to be 51.2 weeks and 21.2 weeks, respectively; however, this difference was not statistically significant. One local tumor recurrence was observed among dogs that had limb-sparing surgery. Significant difference in survival time was not observed between dogs that had limb-sparing surgery and dogs that underwent amputation.

Amputation, Surgical↗
PubMed1992

Bimanual skill development in pediatric below-elbow amputation: a multicenter, cross-sectional study.

The purpose of this study was to investigate the following in children with unilateral below-elbow amputation: (1) development of bimanual functional skills, (2) development patterns relative to able-bodied children, and (3) the relationship between duration of prosthetic wear and bimanual functional performance. Sixty-nine children with unilateral below-elbow amputation, all less than ten years old, were assessed on 14 prosthesis-assisted bimanual ADL, including play, feeding, dressing, and hygiene activities, which have been studied previously in able-bodied children. Bimanual ADL skill development was not delayed in five of the 14 comparisons to previously published standards, but most development patterns had multimodal, nonmonotonic performance profiles. Duration of prosthetic wear and other factors previously believed to contribute to good prosthetic function were not well correlated to ADL skills (r less than .52). Although these children had no CNS dysfunction, it is apparent that below-elbow amputation impedes pediatric ADL skill development. The cause of these delays appears to be complex and is not expressed uniformly among all children; thus, the delays observed are not simply due to mechanical deficiencies of the prosthetic restoration.

Activities of Daily Living↗
PubMedDate not supplied

Adjuvant hyperbaric oxygen therapy (HBO2)for treatment of necrotizing fasciitis reduces mortality and amputation rate.

OBJECTIVE: A retrospective analysis of 42 patients with necrotizing soft tissue infections treated with adjunctive HBO2 to ascertain efficacy and safety. Overall mortality was 11.9% and morbidity 5%. SUMMARY BACKGROUND DATA: Necrotizing soft tissue infections have historically high rates of mortality and morbidity, including amputation. Common misconceptions that prevent widespread use of adjunctive HBO2 for this diagnosis include delays to surgery, increased morbidity, and significant complications. METHODS: Forty-two consecutive patients (average age 56.1) with necrotizing fasciitis presenting to a major referral center were treated with adjunctive HBO2 as part of an aggressive program of surgery, antibiotics, and critical care. Involved areas included the lower abdomen (15 patients), thigh and perineum (9 patients), flank (4 patients), lower leg (3 patients), and arm, shoulder, and axilla (2 patients). Co-morbidities included diabetes mellitus, chronic renal failure, intravenous drug abuse, peripheral vascular disease, and malignancy. RESULTS: Mortality was 11.9% (5 patients). Both amputations (a finger and a penis), occurred prior to transport to our facility. The average number of surgical debridements was 2.8 per patient; 1.25 performed prior to the start of HBO. The infectious process was controlled after an average of 7 HBO2 treatments were administered to ensure successful wound closure. Complications consisted of only mild ear barotrauma in 3 patients (7%), and confinement anxiety in 17 (41%) but did not prevent treatment. CONCLUSION: Compared to national reports of outcomes with "standard" regimens for necrotizing fasciitis, our experience with HBO2, adjunctive to comprehensive and aggressive management, demonstrates reduced mortality (34% v. 11.9%), and morbidity (amputations 50% v. 0%). The treatments were safe and no delays to surgery or interference with standard therapy could be attributed to HBO2.

Adult↗
PubMed2006

Laser technique shows promise in patients at high-risk for amputation.

New approach to amputation prevention shows early promise. Diabetics are particularly vulnerable to complications that can leave them at risk for amputation. However, experts agree that the vast majority of amputations are, in fact, preventable. Now there is a new laser-assisted procedure available that has shown early success at salvaging the limbs of patients who were not good candidates for alternative limb salvation methods. Not everyone is sold on the approach, but early users are enthusiastic about its potential.

Amputation, Surgical↗
PubMed2006

Exploring ethical justification for self-demand amputation.

Self-demand amputees are persons who need to have one or more healthy limbs or digits amputated to fit the way they see themselves. They want to rid themselves of a limb that they believe does not belong to their body-identity. The obsessive desire to have appendages surgically removed to fit an alternative body-image is medically and ethically controversial. My purpose in this paper is to provide a number of normative and professional ethical perspectives on whether or not it is possible to justify surgery for self-demand amputees. In doing so I proceed dialogically, moving between empirical context and normative theory, revealing the taken for granted normative assumptions (what I call the natural attitude--a technical term borrowed from phenomenology) that provide ethical limits to justifying the treatment of self-demand amputees. While I critically examine both Kantian responses against as well as Utilitarian responses for amputation on demand, I conclude that neither normative tradition can fully incorporate an understanding of what it is like to be a self-demand amputee. Since neither theory can justify the apparent non-rational desire of amputation on demand, ethical justification, I argue, falls short of the recognition that there may be a problem. To end, I introduce a meta-ethical idea, "the struggle for recognition," opening up the theoretical possibility of a hermeneutics of recognition before ethical justification that may be more sensitive to the problem of radical embodied difference exemplified by self-demand amputees.

Amputation, Surgical↗
PubMedDate not supplied

Major stump trauma following below-knee amputation. Outcome and recommendations for therapy.

Injury to the stump of a below-knee amputation (BKA) may require revision to a higher level of amputation. We undertook a retrospective review of BKAs performed during a 14-year period. Twenty-three patients suffered trauma to their stumps. Most (80%) trauma resulted from a fall. The severity of the trauma was graded on a three-part scale. Operative reclosure was attempted in 8 cases with 2 successes. Closure by secondary intent was successful in 7 of the 12 attempts. A total of 11 patients had revision to above-knee amputation (AKA) as the final outcome. The severity of trauma correlated inversely with the likelihood of eventual stump salvage. We conclude that primary reclosure or closure by secondary intent should be considered, since in 53% of attempts this results in knee preservation. Analysis of noninvasive vascular testing prior to the BKA was not helpful in predicting successful salvage of traumatized stumps.

Accidental Falls↗
PubMed1991

[Functional state of the respiratory system in the handicapped after amputation of the upper limbs].

There are given the results of study of external respiration function of 45 invalids after amputation of upper limbs, including 20 after amputation of one arm and 25 after amputation of both arms. The study was carried out at rest and with physical loading at veloergometer. Detected disturbances of external respiration function are determined by decrease of reserve capability of respiratory system due to disturbance of dynamic balance of muscular system of shoulder girdle and thorax, muscle atrophy, thorax excursion decrease. There are given recommended locomotory regimens and allowable physical loads and recommendations concerning prosthetics and exercise therapy.

Adult↗