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PubMedDate not supplied

Rehabilitation potential of elderly patients with major amputations.

This study was undertaken to determine the rehabilitation potential of patients undergoing amputation for vascular disease. A total of 101 patients were studied with a mean age of 69 +/- 14 years, 26 of whom were over age 80. Operative indications were gangrene or ulceration in 80% with rest pain in 20%. Eighteen patients were bilateral amputees. Fifty per cent of the patient population had previous vascular operations. The operative mortality was 13% and was not affected by the age of the patients or the presence of diabetes. Most operative deaths were due to cardiac or septic respiratory complications. Twenty-four of 88 surviving patients were not considered candidates for rehabilitation and the major determining factor was the occurrence of a remote or perioperative stroke. None of these 24 patients was discharged from institutional care. Sixty-four patients were considered rehabilitation candidates with equal distribution in all age groups. Ninety-five per cent of these patients were discharged home with 80% of those patients over 80 being discharged. Eighty-seven per cent of the elderly rehabilitation candidates were fitted with prostheses which compares favourably to other age groups. Seventy-three per cent of the elderly reached their rehabilitation goals (most frequently ambulation with the aid of a walker) which is only slightly less than the younger amputation group. From this study we conclude that amputations which are done for ease of nursing care and patient comfort in debilitated patients have a high mortality rate and rehabilitation goals are unlikely to be met. We have demonstrated high success rates with rehabilitation including patients over age 80. The majority of these patients may be discharged home after a period of aggressive rehabilitation.

Activities of Daily Living↗
PubMed1991

Exercise testing and training in patients with peripheral vascular disease and lower extremity amputation.

Patients with peripheral vascular disease have a high risk of coronary artery disease. The risk is even greater when the peripheral vascular disease leads to lower extremity amputation. Exercise testing using lower extremity exercise has been the "gold standard" for screening for coronary artery disease, but many patients with peripheral vascular disease and those with amputations have difficulty doing this type of exercise. Arm exercise ergometry has been shown to be a safe and effective alternative for the detection of coronary artery disease in patients who cannot do leg exercise. This test has also been used to determine safe exercise levels and may be able to predict the ultimate level of prosthetic use in amputees. Exercise training with arm ergometry also improves cardiovascular efficiency and upper body strength in poorly conditioned patients. Studies are needed to appreciate fully the role of exercise testing and training in the recovery of these patients after amputation.

Amputation, Surgical↗
PubMed1991

Per Primam thumb replantation for all patients with traumatic amputations.

Forty-two complete thumb replantations performed between 1980 and 1984 were reviewed. The mean follow-up time was 14 months. Replantation was attempted for all thumb amputations regardless of mechanism or severity of injury. Sixteen (38%) failed intraoperatively or postoperatively. Thumbs with narrow zones of injury showed a significantly higher survival rate than those with wide zones of injury. Eighty percent of those with poor arterial flow intraoperatively ultimately failed, despite pharmacologic treatment and multiple vein-graft anastomoses. Two thumbs with no vein repairs ultimately survived. Reexploration for loss of perfusion succeeded in 60% of cases. Total metacarpophalangeal and proximal interphalangeal active motion postoperatively averaged 68 degrees. Median static two-point discrimination returned to 11 mm. Avulsed thumbs survived in 46% of cases. Replantation should be attempted in all cases of thumb amputation, as success cannot be predicted by mechanism or severity of injury. Thumbs with poor intraoperative flow (20%) or no venous return (50%) can survive and should not be primarily amputated. Vein grafting is not mandatory if shortening allows anastomoses to be tension free. Prompt reexploration of acute vascular occlusions is worthwhile.

Adult↗
PubMed1991

[Economic amputations of the lower limbs due to ischemia. II].

In this second note, some technical details used during amputation are described, leaving out the systematic description of interventions. The analysis of the postoperative period shows that the more distal the amputation, the higher the incidence of local complication, while about postoperative mortality our data show an opposite trend. The Authors conclude by pointing out that an early indication and an accurate evaluation often allow a more distal amputation, that must be as conservative as possible anyway.

Amputation, Surgical↗
PubMed1990

Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections.

A simplified two-stage below-knee amputation for unsalvageable diabetic foot infections was done on 19 limbs with 84% good results for healing. The first stage was the standard below-knee amputation with a long posterior flap in which the fascia and skin were closed in the central portion with the medial and lateral portions of the wound left open for drainage. The second stage was delayed until closure of the open wounds three to seven days after the first stage. Wagner's classification of diabetic foot lesions was used to stratify these cases. Grades 3 and 4 foot infections had a uniformly good prognosis for healing with this surgical technique. Grade 5 foot infections had a poor prognosis for healing, especially if associated with renal failure and dialysis, even with an initial guillotine amputation.

Adult↗
PubMed1990

[2-stage, bilateral femoral amputation in severe arteriosclerosis].

It is reported about 26 patients with lower extremity amputation above knee on both sides in two times because most hardest vascular insufficiency. Amputation is necessary, if all other treatment are unsuccessful or impossible. In these very difficult cases amputation was made on second leg to save life. Especially the problems of treatment after operation are explained.

Aged↗
PubMedDate not supplied

Surveillance for injuries: cluster of finger amputations from snowblowers.

In an investigation of the health effects of a Christmas eve snowstorm in 1982, a review of emergency room records in the Denver area identified a cluster of 17 cases of finger amputations. Fifteen (88) percent of these amputations were associated with snowblower use. An additional 12 persons with hand or finger injuries without amputations from snowblowers were identified. A case-control study was performed comparing these patients with a control group who had used snowblowers. Patients were more likely than controls to have had their machines become clogged with snow (odds ratio [OR], 3.4, 95 percent confidence limits [CL], 0.74-15.4). Using a hand to dislodge trapped snow was the only risk factor identified for the patients (OR, 116; 95 percent CL, 16-820). No differences were found for other variables such as type of snowblower, instruction for use, or previous experience using a snowblower. The findings suggest that the most feasible measure to prevent such injuries is a change in snowblower design to preclude entry of a hand while the machine is running. This investigation illustrates the importance of surveillance in detecting and controlling injuries. Without such surveillance, the similarity among injuries reported on this paper would not have been recognized. Ongoing surveillance for injuries might identify other clusters of injuries.

Accidents, Home↗
PubMed1989

[Minor amputations in treatment of the diabetic foot].

Major amputation is a radical therapeutic principle which should not be undertaken without angiographic evaluation. Since the goal of limb salvage is to limit the ischemic tissue lost in an acral area, it favours minor "borderline" amputation. Of 597 stage IV patients 362 underwent arterial reconstruction (40% diabetics). Limb salvage was performed in 75% of the patients. Followup after 6 years showed that 33% of the patients were able to walk, and 17% had had a secondary major amputation.

Amputation, Surgical↗
PubMed1989

Management of amputation injuries of the male genitalia.

Modern tissue transfer techniques have drastically modified our approach to reconstructive surgery in general. Certainly, the management of traumatic genital amputation is no exception. Although the unique vascular properties of the penis have allowed for astonishingly good results in a number of cases of genital amputation injuries, it is certain that microreplantation procedures make for uniformly good results with a minimum of postoperative complications. After microreplantation, the patient is left with a penis that is cosmetically normal and functionally nearly normal or undetectably abnormal. Although microreplantation offers the best results, certainly in the case of penile amputation, if microreplantation technology is not available, the older corporal reattachment techniques should be offered.

Amputation, Traumatic↗
PubMed1989

Limb reconstruction versus amputation decision making in massive lower extremity trauma.

Massive lower extremity trauma, in particular open tibial fractures with associated vascular injuries, presents an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Unfortunately, the literature to date is deficient in providing sound and defensible guidelines for primary amputation. Individual patient variables, specific extremity injury characteristics, and associated injuries must all be weighed before a decision can be reached. Further prospective studies are necessary before a well-defined protocol for primary amputation can be properly developed.

Amputation, Surgical↗
PubMed1988

[Initial treatment of amputation injuries].

Emergency treatment of an amputation injury is based on the correct assessment of the extent and functional loss of the amputated part. In addition to choosing the best treatment for the patient and amputated part, timely organization of transport and early contact with the replantation center are of utmost importance. We present the results of our experience based on replantations in 323 patients.

Amputation, Traumatic↗
PubMed1986

Segmental amputation with re-implantation in the treatment of malignant bone tumours of the limbs.

Stage 2 B malignant skeletal tumours are currently treated by amputation or disarticulation of the limb. The present paper describes a surgical technique for complete removal of the neoplasm and surrounding soft tissues by resection of a cylinder of the limb complete with skin. The resection of bone and adjacent soft tissues is extended sufficiently proximal and distal to the neoplasm to ensure complete removal of neoplastic tissue. The authors describe two cases; an osteosarcoma of the distal third of the femur and a malignant fibrous histiocytoma of the lower radius. After removing the affected cylinder of the limb, osteosynthesis is performed by one of a variety of methods. The main vessels and nerves are dealt with according to the findings revealed by pre-operative investigations or per-operative findings. If they have to be sacrificed, end to end suture is performed, but if main nerves can safely be spared (as in Case 1) it greatly enhances the functional prognosis. The value of this operation is that it is as radical as amputation while the aesthetic and functional results are equivalent to those of a resection-arthrodesis. The operation has therefore been designated segmental amputation.

Adult↗
PubMed1988

[3 discoveries of amputations in Bern canton, Switzerland].

At La Neuveville (Switzerland) close to the Blanche Eglise a separately buried amputated leg from the 19th century was discovered. The pathological lesions of the knee joints are most likely due to a nonspecific infection (Osteomyelitis). However, postmortal defects made an exact diagnosis difficult. Two foot-amputated male burials were discovered on St. Petersinsel (Switzerland) in the monastery cemetery of the 11th to 15th century. The possible causes of these amputations are being discussed within the historical context.

Amputation, Surgical↗
PubMed1988

Functional considerations in partial foot amputations.

Recent developments in both surgical techniques and prosthetic management have improved the prognosis for foot amputations between the transmetatarsal and Syme's levels. Retention of active ankle motion is often permitted by partial foot amputations. Vocational and avocational requirements for active, voluntary ankle motions should be considered preoperatively in selected patients. Three case reports are used to illustrate this concept. Appropriate surgical techniques and prosthetic devices may improve the quality of life for some individuals requiring distal lower extremity amputations.

Amputation, Surgical↗
PubMed1988

Amputation of the great toe. A clinical and biomechanical study.

Clinical and biomechanical observations were made on otherwise normal feet in ten patients, who had had amputations for pollicization of the great toe. Measureable changes were demonstrated in the patients' gait pattern and in force plate data. The center of pressure was noted to shift from beneath the second metatarsal head on the normal side to beneath the third metatarsal head on the amputated side. The velocity of movement of the center of pressure slowed significantly in the metatarsal head region of the operated side, which secondarily resulted in an increased loading of the metatarsal region. The progression of the center of pressure was noted to be beneath the third metatarsal head region on the involved side, instead of progressing medially and distally toward the first web space. Clinically, the operated foot demonstrated slight thickening beneath the second and third metatarsal heads but no significant abnormal callus formation developed. The patients' shoes all showed increased lateral wear on the amputated side. From a functional standpoint, the patients had little or no disability from loss of the hallux.

Adolescent↗
PubMed1986

Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur.

A retrospective multi-institutional study of 227 patients with osteosarcoma of the distal end of the femur was done to compare rates of local recurrence, metastasis, and survival. Three cohorts of patients who had had either a limb-sparing procedure, an above-the-knee amputation, or disarticulation of the hip were compared. The results revealed prevalences of eight of seventy-three, nine of 115, and zero of thirty-nine as to local recurrence; forty-three of seventy-three, sixty-five of 115, and twenty-one of thirty-nine as to metastasis; and thirty-three of seventy-three, forty-eight of 115, and eighteen of thirty-nine as to death. Of the seventeen patients who had a local recurrence, sixteen died. In the limb-salvage group, eighteen patients required amputation, because of local recurrence in eight and other local complications in ten. The Kaplan-Meier estimates of the percentage of patients who survived and the percentage of patients without recurrent disease showed no difference among the three surgical groups (Mantel-Cox test statistic: p = 0.8) after a median length of follow-up of five and one-half years. Various covariant adjusted estimates yielded similar results. For the entire group of patients, the rate of continuously disease-free survival was 42 per cent, and the over-all rate of survival was 55 per cent at five years. It appears that, compared with above-the-knee amputation or disarticulation of the hip, the use of a limb-salvage procedure for osteosarcoma of the distal end of the femur did not shorten the disease-free interval or compromise long-term survival.

Adolescent↗
PubMedDate not supplied

Hallux amputation for diabetic osteomyelitis.

Digital amputation for infection in the diabetic patient requires accurate assessment of wound healing potential as a function of clinical and noninvasive studies of cutaneous blood flow. The diabetic propensity for staphylococcal infection, microangiopathy, and delayed wound healing may be questionable in light of recent literature. X-rays, xeroradiographs, and bone scans are useful guides to osseous infection involvement. Amputation technical planning is mandatory. Proper assessment results in a dynamic functional amputation stump with little impact on gait.

Adult↗
PubMedDate not supplied

Post-amputation phantom pain and autonomous stump movements responsive to doxepin.

A 40-year old man with post-amputation phantom pain and involuntary autonomous movements experienced dramatic relief of both pain and autonomous movements with administration of the antidepressant doxepin. The pathophysiology of pain and post-amputation autonomous movements, as well as the therapeutic response to doxepin are discussed in terms of the effects of limb amputation on spinal excitability and alterations in both spinal and supraspinal transmitter functions.

Adult↗