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PubMed1986

Delayed skin oxygenation following distal tibial revascularization (DTR). Implications for wound healing in late amputations.

This article summarizes the authors' experience with prospective transcutaneous oxygen mapping (PtcO2 mm Hg) in patients requiring distal tibial revascularization. Simultaneous measurements were performed measuring preoperatively and early (1-3 days) and late (5-8 days) postoperatively in eight patients undergoing DTR (Group 1) at the chest (CT), below-knee (BK), and midfoot (FT) levels. In an additional 12 patients (Group 2), PtcO2 was measured late postoperatively adjacent to forefoot amputations. PtcO2 measurements were made at room air (RA) and after inhalation of oxygen (O2) in order to evaluate restriction of oxygen delivery. Late postoperative PtcO2 at both BK and FT sites increased (P less than .05) compared to either preop or early postop values. Inhaled O2 increased PtcO2 greatest at the FT late postop time (P less than .001). Group 1 amputations and ischemic ulcers all healed within 4 weeks postoperatively, when PtcO2 values were greater than 25 mm Hg. More extensive amputations required in Group 2 also healed when PtcO2 values exceeded 25 mm Hg, but required a hospitalization period almost three times as long as that of Group 1.

Aged↗
PubMed1979

[Reconstructive measures to prevent lower extremity amputation for atherosclerotic occlusive disease in old age and the results obtained between 1973 to 1977 (author's transl)].

Within a 5-year-period 102 patients over the age of 70 were admitted with atherosclerotic occlusive disease. All patients had rest pain or necrosis. In 12,8% only a primary amputation could be performed. The procedures and results of reconstructive surgery on 89 patients were demonstrated: mortality rate of 11,2%, a secondary amputation rate of 13,5% and improvement of 75,3%. The problems after amputation in the senium are discussed.

Age Factors↗
PubMed1985

V.A. Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: III. Definitions and review of design and baseline characteristics.

This report summarizes the major design features, methods, and baseline characteristics of patients enrolled in a Veterans Administration Cooperative Study. In eleven V.A. centers, 231 male diabetic patients who had either a recent amputation for gangrene (N = 207) or active gangrene (N = 24) were randomly assigned to a group which received aspirin (325 mg t.i.d.) plus dipyridamole (75 mg t.i.d.) (N = 110) or two placeboes t.i.d. (N = 121). Major end point were vascular death and amputation of the opposite extremity for gangrene. Forty-one percent of the 563 patients screened were enrolled during a 39 month period. Enrollment errors were found in 8.7%. Historically, the two groups were well matched regarding the following variables: age, duration of diabetes, insulin therapy, previous oral agent therapy, hypertension, myocardial infarction, congestive heart failure, renal disease, sensory neuropathy, and smoking. The drug therapy group had an increased frequency of a history of cerebrovascular disease (19% vs 7%, p = 0.01). The groups were well matched regarding amputation site, obesity, extent of lower extremity vascular disease, retinopathy, and neuropathy upon examination. Their baseline fasting values of glucose, cholesterol, triglycerides, and creatinine were also comparable. We conclude that this study should provide definitive data on the efficacy of these antiplatelet agents in preventing further vascular disease in this patient group. It should also provide new prospective data on the natural history of vascular disease, and the association of vascular risk factors with subsequent vascular events in this patient population.

Amputation, Surgical↗
PubMed1985

Fingertip amputation: review of 100 digits.

Evaluation of the functional results and complications of 100 fingertip amputations revealed no difference between the two most commonly used repairs; 52 injuries were treated by primary closure with residual viable skin flaps and 27 by split-thickness skin grafting. No decline in unfavourable functional results was found when patients evaluated 6 weeks after injury were compared to patients evaluated 42 weeks after injury, suggesting that delaying the patient's return to full activity by prolonging rehabilitation is unlikely to yield much improvement. Shortening the nerves in proximal amputations closed by residual flaps did not decrease nerve irritation. Resection of bone produced a mobile amputation-stump tip. While the mean time off work or return to full activity following skin grafting was 6 days less than it was after primary closure, the difference was not significant.

Absenteeism↗
PubMed1985

The association between lowest palpable pulse and wound healing in below knee amputations.

A retrospective study of 191 patients undergoing 203 Burgess type below knee amputations for end-stage peripheral vascular disease showed that the only clinical feature which associated significantly with wound healing was the lowest palpable pulse. The pulse level was noted preoperatively and was compared with the healing rates in the amputation stumps. When the femoral pulse was absent, 79% of below knee amputations failed. When the femoral pulse was palpable, only 29% wound breakdown occurred. When the popliteal or more distal pulses were palpable, only 10% failure was recorded.

Adult↗
PubMed1973

Finger tip amputations. Review of procedures and applications.

Repair of finger tip amputations depends upon the slope of transsection and how much of the tip has been amputated. Type 1 and 2 injuries are easily handled in the emergency room by local flaps with results acceptable by functional and economic criteria. Type 3 amputations with losses of less than 25 percent can be repaired by primary closure. Losses of 50 percent or over are best treated by local or "distant" flaps from the involved or adjacent fingers or palm. Each style of flap and technique has advantages and disadvantages.

Amputation, Surgical↗
PubMed1981

Improvement of amputation level by lower extremity revascularization.

Improvement of amputation level, with a resulting increase in the ambulatory rehabilitation potential, was achieved in ten patients requiring extirpation of the lower extremity because of gangrene. Arterial reconstruction, percutaneous transluminal dilation or chemical lumbar sympathectomy, or a combination of these modalities, was used to achieve primary healing at an amputation site at least one level below that initially suggested by clinical and noninvasive diagnostic means. Patients requiring amputation of the lower extremity who are good candidates for ambulatory rehabilitation should undergo an aggressive diagnostic and therapeutic search for treatable proximal arterial lesions, thereby preserving limb length and increasing the likelihood of independent prosthetic use.

Amputation, Surgical↗
PubMed1984

Use of a pylon for early ambulation after below-knee amputation: a preliminary report.

The fitting of a prosthesis immediately after amputation offers many advantages. These include early ambulation, more rapid healing of the amputation site and a decrease in the number of complications resulting from prolonged bed rest. The major problems preventing the widespread use of immediate fitting are the specialized prosthetic care required and the high cost of the appliance. The authors describe a new pylon designed for early ambulation after below-knee amputation. Its application does not require special training, it is inexpensive, safe and effective. This pylon was used in the early postoperative period in 20 amputees, without any major complications.

Adult↗
PubMed1984

Lower extremity amputation for peripheral vascular disease. A low-risk operation.

Two hundred fifty-three consecutive major amputations of the lower extremity for peripheral vascular insufficiency were performed over a 3-year period. Operative mortality was 0.9 per cent for 113 below-knee and 2.8 per cent for 140 above-knee amputations. Although lower extremity amputation has a reputation for high mortality and morbidity, this is unwarranted; adherence to a protocol of aggressive medical management with timely surgical intervention allows a mortality that is appropriate to the age and general debility of this patient population.

Aged↗
PubMed1984

Nerve entrapment syndromes in the upper extremity contralateral to amputation.

Five cases are reported of upper extremity amputation with no metabolic disease. Patients experienced pain, paresthesia and weakness in the intact extremity associated with electrophysiologic evidence of entrapment neuropathies. All patients did heavy manual work, and all had carpal tunnel syndrome. One patient also had cubital tunnel syndrome and compression of the medial cord of the brachial plexus in the axilla, and another patient had cubital tunnel syndrome and axillary neuropathy. Surgery did not relieve symptoms of carpal tunnel and cubital tunnel syndromes for prosthesis users until the figure-8 harness was changed. Patients who did not use a prosthesis felt relief of symptoms following surgical release. Possible mechanisms which produce nerve entrapment syndromes in patients with upper extremity amputations are use of one limb for heavy manual work over prolonged periods, direct compression of neural structures from the axilla loop of a figure-8 harness, and compression of neural structures in the axilla resulting in entrapment at a distal site. Changing the figure-8 harness should be considered prior to surgical decompression for patients who have upper extremity amputations with entrapment syndromes.

Adult↗
PubMed1984

Popliteal and infrapopliteal arterial injuries. Differential management and amputation rates.

A 3-year clinical experience is analyzed to define preferred surgical management and amputation rates for popliteal as well as infrapopliteal arterial injuries. Ten patients with popliteal arterial trauma were successfully managed without amputation, however, five of 11 (45%) patients with infrapopliteal arterial trauma required amputation. While essentially all popliteal arterial injuries mandate repair, recommendations for repair or ligation of isolated tibial arterial injuries are based on presence of distal ischemia, the patient's associated injuries, as well as estimated operating time for reconstruction. With injury to two or three infrapopliteal arteries, distal ischemia is usually present and arterial repair indicated, unless there has been severe crush injury, prolonged delay, or extended surgery would jeopardize the patient's life. A management protocol for patients with distal ischemia related to popliteal or infrapopliteal arterial trauma should include prompt surgical intervention, liberal use of fasciotomy, intraoperative arteriography, as well as the selective use of intraluminal shunts.

Adolescent↗
PubMedDate not supplied

Determination of amputation level in ischemic legs by means of transcutaneous oxygen pressure measurement.

A new technique for the determination of the most appropriate amputation level in ischemic legs is described and the results obtained in 31 amputations are reported. This method takes the line joining the points with transcutaneous partial oxygen pressure (tcPO2) of 30 mmHg as the lower margin of the incision. A success rate of 90.3%, with primary healing, was obtained in the 31 amputations performed.

Amputation, Surgical↗
PubMed1984

Amputations following motorcycle accidents. A 1-year experience.

Of 110 patients who had recently undergone an amputation and were seen at the Amputee Service at the Johannesburg Hospital during January 1982- February 1983, 40 had required post-traumatic amputations following motorcycle accidents. The majority of these patients had sustained such severe bone and soft-tissue damage that it had been necessary to perform amputation on the day of admission. The high morbidity following motorcycle injuries is cause for concern and recommendations to reduce the rate of injury are offered.

Accidents, Traffic↗
PubMed1983

Revascularization surgery: impact on lower extremity amputations.

The effect of revascularization surgery on the amputee population of 2 hospitals (VA and private) was studied in 2 time periods a decade apart--1969-70 and 1979-80. In the VA hospital there was a trend toward below-knee surgery over time; however, for patients who had prior vascular reconstruction and who ultimately came to amputation there was no change in the proportion of below-knee to above-knee surgery at either hospital. At the private hospital the average age of patients who underwent amputation increased significantly and the proportion of patients requiring amputation to the total number of patients undergoing vascular reconstruction significantly decreased in the later time period.

Aged↗
PubMed1983

Devices to enable persons with amputation to participate in sports.

Participation in physically challenging competitive sports is as important to some persons with amputations as are work and leisure, both of which are ordinarily of a sedentary character. Sports participation contributes not only to physical but also to psychologic well-being. The manner in which a prosthetic clinic team can aid in this aspect of rehabilitation is discussed. Some of the more sophisticated prostheses prescribed to enable participation in sports include above-knee and below-knee water-resistant prostheses for swimmers, an adjustable foot-ankle unit for the proficient swimmer and scuba diver, prostheses and special equipment for skiers, special devices for golfers with upper extremity or lower extremity amputations, and various commercially available terminal devices to enable persons with an upper extremity amputation to bowl, to hold a fishing pole and reel, to play baseball, to hold tools, to fire a pistol, and to swim.

Amputation, Surgical↗
PubMed1983

Vascular surgical audit-arterial reconstructions and amputations for lower limb ischaemia.

There were 750 arterial reconstructions and 2134 major amputations in hospitals within the South West Regional Health Authority (SWRHA) from 1974-1978, according to a Hospital Activity Analysis (HAA) based survey of all patients undergoing these operations for atherosclerotic limb ischaemia. Those undergoing arterial reconstruction fared better than amputees in terms of hospital mortality (5.2% vs. 21%) and length of hospital stay (21.4 days vs. 47 days). Comparison of the HAA results with case records and operating theatre books at Bristol Royal Infirmary showed a failure-of-inclusion rate of 10% for arterial reconstructions and 9.3% for amputations. There was a difference in the proportion of arterial reconstructions to major amputations (2.5:1) at Bristol Royal Infirmary compared with SWRHA hospitals (1:3), but hospital stay and operative mortality were similar.

Amputation, Surgical↗
PubMed1983

[The effect of prolonged hypokinesia on hemodynamics and myocardial contraction in patients with ischemic heart disease after amputation of the extremities].

Echocardiographic investigation revealed changes in central hemodynamics and myocardial contractility, associated with lasting hypokinesia, in coronary patients after the amputation of a limb that differed significantly from those recorded in patients with intact limbs. Amputation of a limb, lasting hypokinesia, physical overstrain, negative emotions, disorders of myocardial electric and contractile functions, central and peripheral hemodynamic disorders all contribute to the risk of coronary disease, myocardial infarction and death in post-amputation patients.

Adolescent↗
PubMed1981

A clinical trial of a combination of amoxycillin and flucloxacillin in amputations for septic ischaemic lower limb lesions.

The incidence of sepsis after amputation with or without a proximal arterial reconstructive procedure in 24 patients presenting with septic ischaemic lower limb lesions and who received a parenteral combination of amoxycillin and flucloxacillin (Suprapen; Bencard) is compared with that in a similar control group of 22 patients who received antibiotics only if postoperative sepsis developed. There was no significant difference in the incidence of sepsis in the arterial reconstruction wounds. Amputation stump sepsis occurred in 33.3% of patients receiving prophylactic antibiotics compared with 72.7% of the control group. The difference is statistically significant. A similar significant difference was found among 32 patients submitted to primary amputation without an arterial reconstructive procedure. Bacteriological data are discussed.

Adult↗