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At least 1,477 records · Page 82Linked to original sources
PubMed1993

Stage-dependent effects of retinoic acid on the regenerating limbs of larval Korean salamander, Hynobius leechii, at two amputation levels.

The morphological and biochemical data obtained in this series of experiments clearly confirm the previous finding about the relationship between the stage of limb regeneration and the effects of RA on duplication, i.e., the most sensitive stage for RA-induced duplication is the stage of dedifferentiation, regardless of the level of amputation. However, when the RA effects were expressed as a function of time after amputation, the upper arm regenerates clearly showed a prolonged and delayed response to RA treatment compared to the lower arm regenerates. These findings were further supported by the data on acid phosphatase activity, which may reflect the level of dedifferentiation. Furthermore, the slow increase of this enzyme activity above the control level until 8 days after RA-injection corresponds to the late appearance of limb regenerates after RA treatment. At present, we do not have any clear explanation why upper arm regenerates and lower arm regenerates show differences in the MLP's and different temporal profiles for the RA-evoked limb pattern duplications. However, the difference in the level of dedifferentiation after simple amputation and after RA-treatment suggests that RA-induced changes in the positional identity of blastema cells may require a prolonged and augmented state of dedifferentiation. In this scheme, the level and type of CRABP may play a critical role as suggested in the case of regenerating axolotl limbs (McCormick et al., 1988).

Acid Phosphatase↗
PubMed1994

Amputation after failed total knee arthroplasty.

From 1983 to 1992, nine above-knee amputations were performed in eight patients for complications after total knee arthroplasty. The mean time from the initial knee replacement to amputation was 9.7 years. The average age of the four men and four women was 72 years. Eight knees had chronic infection and one had intractable pain after four revision attempts for aseptic loosening. Most patients had two revision arthroplasties after the original implant. In this series, the common factors that lead to amputation were multiple revision attempts in the presence of chronic infection, severe bone loss, and intractable pain. Earlier consideration of arthrodesis rather than multiple revision attempts is recommended to avoid such a poor outcome.

Aged↗
PubMed1994

[Amputation in geriatric patients].

The incidence of amputation rises dramatically in old age. Trauma and tumors are uncommon reasons in this age group, however; 90% of amputations in such patients are performed for occlusive disease. These patients are distinguished from all other amputees by their multiple morbidity, which must be borne in mind at all stages, from the decision to operate to rehabilitation. This paper briefly indicates the points that are important for an optimal result of rehabilitation, starting with selection of the amputation level and extending through to provision of the prosthesis and mobilization. The paper ends with a presentation and discussion of the results of rehabilitation in 90 patients aged over 70.

Aged↗
PubMed1993

Gait analysis in peripheral vascular insufficiency through-knee amputation.

Due to recent improvements in prosthetic limb componentry, through-the-knee (knee disarticulation) amputation has gained new interest for rehabilitation-minded amputation surgeons. Recent objective scientific studies from our gait analysis laboratory have described the walking characteristics of peripheral vascular insufficiency through-knee amputees, and have compared their function with similar patients amputated above (transfemoral), or below (trans-tibial), the knee joint. This paper provides a summary of that available information.

Amputation, Surgical↗
PubMed1994

Lower extremity amputations in New Jersey.

We compared the incidence of nontraumatic lower extremity amputations in the diabetic and nondiabetic populations in New Jersey. The diabetes-related lower extremity amputation rate was 80.1/10,000 diabetic population, while the rate for nondiabetes-related amputations was 1.6/10,000 population.

Adolescent↗
PubMed1993

Thru-knee amputation: the operation of choice for non-ambulatory patients.

Between 1983 and 1990, 32 consecutive patients had 35 thru-knee amputations for ischemia causing infection or gangrene of the lower leg. Twenty-seven patients were nonambulatory, five had limited mobility, and none were considered to be candidates for rehabilitation with a prosthesis after surgery. The average age was 73 years. Thirty-day hospital mortality was 3 per cent. The incidence of complications was low, and healing was achieved in 97 per cent of survivors. One patients required revision to an above-knee amputation. Average postoperative hospital stay was 8.7 days. It is concluded from this study that thru-knee amputation is the treatment of choice in patients with nonsalvageable ischemic legs and in whom ambulation is not planned after operation.

Aged↗
PubMedDate not supplied

Amputations of the foot and ankle. Current status.

Doppler assessment of ankle and foot systolic pressure is a practical aid in the evaluation of neurocirculatory problems. If the ratio of ankle pressure to arm pressure is over 0.45, more than 90 per cent of operative procedures will heal. Intraoperative testing of blood supply aids in determining level of amputation. Healing results in 80 per cent of cases if bleeding occurs in the skin within three minutes after release of tourniquet. With vigorous debridement of infected soft tissue and bone, the remaining tissue will often heal in local foot operations. A high percentage of patients with neuro-circulation disorders become bilateral amputees. Partial foot and Syme level amputations allow these patients to remain prosthetic users. Function tests show the Syme amputee to be superior in stride length, velocity, cadence and oxygen uptake when compared with the below-knee and above-knee amputees. The criteria of McKittrick must be followed carefully to ensure healing of transmetartarsal amputations.

Amputation, Surgical↗
PubMedDate not supplied

[Gritti's amputation in vascular surgery].

Gritti's amputation was performed in 35 patients, mean age 71 years, with vascular disease of leg. There was no immediate postoperative mortality. Of twenty patients fitted with an appliance using a specific technique, only one had a poor functional result. The results obtained in this preliminary series were compared with those after amputations and knee disarticulations. They showed that Gritti's amputation should be considered for patients with arteritis when a functional knee is impossible to conserve.

Adult↗
PubMed1977

[Radical surgery (amputation) or conservative treatment (drainage) in cases of septic pedal arthritis and navicular bursitis in cattle (author's transl)].

An observation was carried out with regard to forty-nine cows, which had been treated for a purulent necrotizing arthritis as a complication of a rear leg. In seventeen cases the pedal joint was drained by means of track made by an electric fraise. In sixteen cases the claw was amputated under the coronet and in the remaining sixteen cases the claw was sawn off above the coronet, through the second phalanx. It emerged that from the seventeen drainage-cases nine patients were retained for several laction-periods. Thirty out of the thiry-two cows where a claw-amputation had been performed, were slaughtered within one year. If a cow is not to be retained for several years after treatment, a simple amputation above the coronet is to be recommended.

Amputation, Surgical↗
PubMedDate not supplied

A new technique of open amputation: use of the rolled flap.

In patients with extensive skin, soft tissue or bone loss and chronic osteomyelitis, or vascular disease, one feature in common is a source of potential infection in that limb. An amputation is often advisable but primary closure frequently results in complications. The above described method of open amputation enables us to retain the optimum bone length and skin flaps without basing the level of the amputation upon the apparent proximal level of normal skin. This method is expecially useful in the acutely traumatized and unsalvagable limb with gross contamination, and can produce early primary healing.

Amputation, Surgical↗
PubMed1996

Major lower limb amputation for vascular disease in the Grampian area: the outcome of rehabilitation.

The outcome of lower limb amputation in the Grampian Region has been studied. In the years 1990-1991, 93 patients had 104 amputations for vascular disease. Rehabilitation was supervised by a multidisciplinary team. The amputation level was: unilateral and below-knee (BKA), 55 patients; unilateral and above-knee (AKA), 27 patients; and bilateral (BA) in 11 patients. At a median follow-up of 27 months, survivors who had had a limb fitted were sent a questionnaire to assess their physical mobility. The response rate was 95%. There were 33 (60%) survivors in the BKA group. Fourteen patients (25%) indicated good mobility and seven (13%) indicated fair mobility. There were five (19%) survivors in the AKA group, only one of whom described fair mobility with a prosthetic limb. There were 5 (46%) survivors of BA. Two described good and one fair mobility. Although vascular amputees have a high mortality rate, physical mobility tends to be good in those fitted with a prosthesis after BKA.

Activities of Daily Living↗
PubMed1996

Amputation surgery and prostheses.

Wide surgical margins in surgery for a bone tumor can be accomplished either by local excision or by amputation surgery. Amputation surgery has less morbidity than limb salvage surgery. Prosthetic replacement in the lower-extremity amputation should provide an artificial limb that will be comfortable and stable for weight bearing. Retention of the anatomic knee joint is critical for better ambulation and less energy expenditure. Upper-extremity prosthesis should be functional and cosmetically acceptable.

Amputation, Surgical↗
PubMed1996

[The fate of patients with diabetes mellitus after amputation of a lower limb as a consequence of gangrene].

The aim of study was to analyse factors that modified the survival time of 125 patients with diabetes mellitus and 121 patients with normal tolerance glucose to whom amputations of a lower limb in consequence of gangrene were performed. The prospective study were started on 5th January 1989 and finished 31st December 1993. Among the examined patients with NIDDM were 66 men in the age from 53 to 88 years (mean age 66.8 +/- 8.5 (+/-SD) years) and 48 women in the age from 58 to 91 years (mean age 71.8 +/- 9.1 years). Among the examined patients with IDDM were 6 men in the age from 40 to 65 years (mean age 55.7 +/- 9.7 years) and 5 women in the age from 34 to 72 years (mean age 53.7 +/- 13.6 years). The mean duration of NIDDM among men was 14.1 +/- 8.6 years, among women - 13.6 +/- 10.2 years and the mean duration of IDDM among men was 26.1 +/- 6.7 years, among women-26.0 +/- 10.8 years. In that period among patients with diabetes mellitus 80 patients died (64 percent), and among patients with normal glucose tolerance-died 39 patients (32 percent). In the analysis of survival time of patients with diabetes mellitus after nontraumatic amputation of a lower limb the following factors were the essential predictors of death: age (p = 0.0001), duration of diabetes (p = 0.03), arterial hypertension (p = 0.006), peripheral arterial disease (p = 0.0007), diabetic nephropathy (p = 0.0065). Among patients with normal tolerance glucose only the age was the essential predictor of death (p = 0.0001). The necessity of performance of amputation of a lower limb among patients with diabetes mellitus provides information on unsuccessful course of disease.

Adult↗
PubMed1996

[Reconstruction surgery after traumatic amputation of the thumb].

Reconstruction of the thumb after traumatic mutilation constitutes a delicate indication in order to select the technique most adapted to the patient's functional needs and esthetic desires. Pollicizations of healthy fingers are now used less frequently, except in the clinical context of very proximal amputations, but amputations of mutilated fingers remain a frequent indication. Progressive lengthening was associated with a high complication rate, although these complications have remained minimal. Osteoplastic reconstruction is still occasionally indicated in its modern version of composite flap. Finally, toe transfers now have a large place in young subjects, "tailored" transfer is preferred to first or second toe transfer in the case of isolated amputation of the thumb, due to its esthetic advantages.

Amputation, Traumatic↗
PubMedDate not supplied

[Limb amputations carried out in hospitals of the national health service in the years from 1990 to 1993].

This study was to assess the number of limbs amputations in Portugal State Hospitals over a four years period (1990 to 1993), analysing their incidence according to etiology, sex, average age, duration of hospitalization, level of amputation and mortality rate. The authors emphasise the levels of amputation which are mot favourable for an effective rehabilitation.

Amputation, Surgical↗
PubMed1996

Results of minor foot amputations in diabetic mellitus.

The aim of this retrospective study is to study the outcome of surgery in diabetic patients with foot infections. The results of 54 local amputations performed by surgeons of different levels of experience for gangrene and/or deep infection confined to the toes in diabetic patients were studied. Failure of surgery is defined as any case that requires subsequent surgery. Twenty-two of the initial local amputations subsequently required higher amputations. The majority of these cases that failed were done by junior officers of Medical Officer and Registrar grade. In contrast, the cases done by senior surgeons are more likely to heal. Fifty-six percent of the initial operations done by Medical Officers failed. A similar pattern is also seen in repeat operations done by junior officers. Based on our findings, it is recommended that the decision making must be made by senior staff of at least Registrar grade. Repeat surgery should also be done by senior staff. Finally, continued training and supervision of junior staff are necessary to improve their technical expertise, judgment and knowledge.

Adult↗
PubMedDate not supplied

Helping the patient through the experience of an amputation.

Due to the complications of diabetes mellitus or peripheral vascular disease, the older adult may face the experience of amputation. The patient with an amputation and the family will need psychologic support as well as information about preoperative and postoperative concerns and education in the knowledge and skills needed for rehabilitation and selfcare. The nurse plays a key role by providing the necessary information, emotional support, and education. Continuity of care throughout the experience is critical so that the patient and family can adjust to the amputation and the patient can again become an active member of society.

Adaptation, Psychological↗
PubMed1997

Toe amputations and ray resections.

Loss of a part of the lower extremity is an unfortunate complication of diabetes. Indications and general principles of amputation have been established. Distal limb salvage procedures include forefoot amputation alternatives, digital amputations, and ray resections. A variety of risks and complications are associated with these procedures. Postoperative management including prosthetic and accommodative therapy may enhance the successful outcomes of these procedures.

Amputation, Surgical↗