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PubMed1997

[Restorative microsurgery in severe injury and traumatic amputation of the distal portions of the extremities].

Application of microsurgical methods and free grafting of the compound complexes of tissues with the vessels and nerves in particular with microanastomoses permitted to achieve high functional results in traumatic amputation of extremities in contiguity, severe destroying traumas and their consequences. Experience of 1000 urgent microsurgical operations, including 638 replantations of digits and their blocks for various kinds of amputation on the palm level was summarized. Classification of amputation, taking into account the injury mechanism and character, promoting the choice of optimal tactic and technique of restoration operation was elaborated. Indication for replantation are substantiated, the results of restoration operation, complications occurring after large segments of extremities replantation and measures for their treatment are analysed. Definite success of operation is determined by the extent of first operation and by subsequent rehabilitation measures conduction including the correcting operations and various conservative methods.

Amputation, Traumatic↗
PubMed1997

[Diabetic foot syndrome and its risks: amputation, handicap, high-cost sequelae].

Amputation, Handicap, High Subsequent Costs. Lack of "Outpatient Wards for Diseases Involving the Feet" in German hospitals. A Challenge to Prevention: In consequence of diabetic polyneuropathy, about 25% of all diabetics develop neuropathic foot complications often resulting in amputation (about 30,000 cases in Germany per annum). Suffering and handicaps of the patients, as well as the high costs involved (estimated at 800 million Deutsche Mark per annum) systematic prophylaxis and early identification of patients at risk are imperative. According to experts every second amputation could be avoided if treatment of diabetic foot complications is started as early as possible. To prevent expensive in-hospital treatment, an outpatient clinical treatment may be offered on an interdisciplinary basis (internist, neurologist, orthopaedist, surgeon, radiologist). About 50 "outpatient wards for diseases involving the feet" exist up to now in German hospitals. Appropriate fees, subsidy by sick funds (and if necessary by politicians) and co-operation with general practitioners, internists etc. are indispensable. Other important co-operators are the family doctors. With regard to health care, preventive activities and publicity, co-operation of the local Public Health departments would also be feasible.

Ambulatory Care↗
PubMed1976

Management of the patient requiring leg amputation for peripheral vascular disease.

Most leg amputations are performed because of the effects of peripheral vascular disease. Only 50% of such amputations were performed below the knee in Ontario in 1972, although the knee joint should be preserved in most patients. Careful preoperative evaluation is essential. Postoperative problems include gas gangrene for which prophylactic measures are recommended; failure of the stump to heal, which necessitates early revision of the stump; and defects in stump contour, which necessitate late revision. An enthusiastic team approach to rehabilitation is necessary to overcome the physical and mental problems that result from amputation of a leg.

Amputation, Surgical↗
PubMedDate not supplied

[Amputation in the growth period].

Amputations during childhood and juvenile age differ from those in adults: Osseous over-growth can be expected especially in trans-humeral and trans-tibial stumps,--to be prevented by stump-capping. After loss of a growth-plate transosseous stumps will reduce growth; therefore it is crucial to preserve the distal femoral growth-plate and a weight-bearing knee-disarticulation stump with respect to future prosthetic function and appearance. Besides predominantly traumatic origin of acquired amputations in the growth-period longitudinal deficiencies present at birth have to attract utmost attention when decision-making for surgical conversion--e.g. of a missing tibia to a knee-disarticulation stump or severe fibular deficiency to a weightbearing Symeor modified Pirogoff-/Boyd-stump. The multiple limb-deficient child and adolescent depends on a holistic approach towards therapy provided by specialised centers.

Adolescent↗
PubMed1989

Amputation for antipersonnel mine injuries of the leg: preservation of the tibial stump using a medial gastrocnemius myoplasty.

Antipersonnel mines are very commonly used in modern warfare. They produce a recognisable pattern of injury to the leg, which frequently spares the gastrocnemius muscle. Surgical amputation is often indicated. Medial gastrocnemius myoplastic below-knee amputation is suitable for these injuries. The technique permits cover and preservation of an acceptable tibial stump.

Amputation, Surgical↗
PubMed1988

Rehabilitation of musicians with upper limb amputations.

Three saxophone players with upper limb amputations have been successfully rehabilitated to play their musical instruments using skin-conductivity touch control. Each attained a standard of musicianship sufficient to perform the standard repertoire of the instrument in a concert setting. The mechanical and electrical modifications to the saxophone are described, as well as the principles of operation of the skin-conductivity touch control module. The touch control module is commercially available for prosthetists who wish to fit musicians or others with upper extremity amputations who require rapid accurate control of a number of channels of powered prosthetic function.

Amputation, Surgical↗
PubMed1996

Morphogenesis and differentiation of grafted blastemas formed in vitro from amputated hindlimbs of larval Xenopus laevis.

The present study was designed to test the morphogenetic potency of limb blastemas formed in vitro from amputated limbs of larval Xenopus laevis. Hindlimbs of larvae at stage 55 (according to Nieuwkoop and Faber [1956] Normal Table of Xenopus laevis (Daudin)) were amputated through the tarsalia, excised at the base of the thigh and cultured in Leibovitz's L-15 supplemented with 2% FCS. After 8-10 days, 50% of the cultured limbs formed a conic blastema on the amputation surface. However, on the excision surface no blastema was present. Three different parts (blastema, blastema with the shank region and proximal part of the limb) of the cultured limbs were then grafted to the axial musculature or to the hindlimb of stage 57 host larvae. Results showed that the blastema formed in vitro were true autodifferentiating regeneration blastemas, since they were able to form well-differentiated autopodia not only when grafted with the shank region to a neutral territory (axial musculature) or to the limb territory, but also when transplanted alone to the two environments. The morphological complexity (no. of toes) of the autopodia differentiated from the grafted blastemas was superimposable to that observed in vivo. Moreover, as in vivo, the entire regeneration process was nerve-independent. In fact, the regeneration blastemas, formed in vitro in the complete absence of nerves, could grow and differentiate also when grafted to denervated host limbs. The grafted proximal parts of the cultured limbs never formed a regenerate.

Animals↗
PubMed1976

Effects on adult newt limb regeneration of partial and complete skin flaps over the amputation surface.

The influence of the wound epithelium on the cellular events preceding blastema formation was examined by comparing dedifferentiation, DNA labeling indices, and mitotic indices of the distal mesodermal tissues in control regenerating newt forelimbs and in amputated forelimbs covered with a flap of full thickness skin. Three kinds of results were seen following the skin-flap graft operations. Epidermal migration across the amputation surface was completely inhibited in 22% (8) of the cases and these limbs repaired the amputation wound but did not form regeneration blastemas. In 11% (4) of the experimental limbs, essentially normal wound epithelia displaced the skin flaps and the limb stumps formed blastemas and regenerated. The majority of the skin grafts (67%) exhibited epidermal migration restricted to the free edges of the flaps. These limbs formed eccentric blastemas on the ventral side of the limb next to the dermis-free epidermis and regenerated laterally in that direction.

Animals↗
PubMed1979

Regenerative responses in larval axolotl limbs with skin grafts over the amputation surface.

Complete flaps of whole skin over the amputation surface of larval axolotl limbs did not prevent dedifferentiation, DNA synthesis, and mitosis. However, even by two weeks, insufficient cell division had occurred for blastema formation. In about 50% of the cases, small areas of wound epidermis formed over the amputated tip of the radius or ulna. At two weeks after amputation, mitotic figures and dedifferentiated cells which incorporated H3-thymidine were predominantly located in the vicinity of the small area of wound epidermis. Although delayed in relation to controls, these limbs regenerated. The results are consistent with the view that the wound epidermis is necessary to maintain dedifferentiated cells in the cell cycle.

Ambystoma↗
PubMed1985

Necessity of an adequate nerve supply for regeneration of the amputated pectoral fin in the teleost Fundulus.

The present work deals with determination of the threshold of nerve fibers per unit of amputation surface necessary for regeneration of the pectoral fins of a teleost, Fundulus. Partial denervation of the amputated pectoral fins, i.e., resection of one or two of the three nerves of the brachial (=pectoral) plexus revealed that the presence of a single one allows the amputated fin to regenerate. From these data and others obtained previously, it is concluded that the nervous requirements for a teleost fin to regenerate are similar or slightly lower than those for tetrapods, for example in the newt, which are capable of appendage regeneration.

Animals↗
PubMed1988

Electrical responses to amputation of the eye in the mystery snail.

Immediately following amputation through the eyestalk of the mystery snail (Pomacea), a persistent ionic current enters the apical amputation surface of the eyestalk stump. The circuit is completed by current driven from undamaged integument of the eyestalk stump and other body regions. The current is relatively steady during the first 10 hours following amputation. Currents subsequently begin a slow decline to base line levels by 60 hours postamputation--a time coincident with wound healing processes. The "battery" driving this ionic current is the internally negative transepidermal potential existing across the snail integument--perhaps the result of a net inward pumping of chloride across the skin. This system is compared to other regeneration models such as the amphibian limb, bone fracture repair, and skin wound healing. We suggest that ionic current may be a control of eye regeneration in the snail.

Animals↗
PubMed1977

Inhibition and axial deviation of limb regeneration in the newt by means of a digit implanted into the amputated limb.

This research was designed to follow up the observation of Thornton and Kraemer ('51) that regressed, denervated limbs of Ambystoma larvae will not regenerate upon reinnervation if all digits on the limbs were not completely resorbed. The object of this experiment was to determine whether the presence of an apical structure, protruding past the amputation surface, would affect the regenerative process. Both forearms of adult newts were amputated midway between the elbow and the wrist. One limb served as a normal regeneration control, and in the other limb the third digit from the removed hand was implanted in place of the removed radius, so that the three distal phalangeal segments protruded past the plane of amputation. Blastema formation in the experimental limbs was delayed by several weeks as compared with control limbs. Approximately one third of the experimental limbs did not regenerate. The regenerates that did form were strongly deviated (45-90 degrees) radially from the longitudinal axis of the limb. Experimental analysis showed that the delay in regeneration is due largely to the projecting part of the digit. The radial deviation of the regenerates is not due to the digital implant, but rather to the removal of the radius. Trauma alone does not account for this phenomenon.

Ambystoma↗
PubMed1984

The tail flattening reflex in Lumbricus: reconstitution after tail amputation and modifications in segmental nerve roots.

On stimulation of the head, the caudal 20-30 segments of intact earthworms exhibit a marked dorso-ventral flattening reflex which is an element of the escape response. When the tail is removed this reflex is reconstituted gradually in segments anterior to the amputation level without regeneration of new tail segments. It takes longer to reestablish the flattening if larger parts of the body are cut off, but after 60 days p.o. all animals regained the full response independent of the number of segments amputated. Extirpation of three consecutive ganglia from the ventral nerve cord also suffices to develop flattening anterior to the operated segments, but the reaction is less pronounced and appears later than after tail amputation. Moreover, it vanishes at the same time the normal tail flattening is observed again, presumably after regeneration across the gap in the cord. In different regions of the body, area and perimeter distributions of transversely sectioned axons in the three pairs of segmental nerves (SN I-III) of the cord were measured. Characteristic changes along the length of the animal were found for SN I and SN III. In tail segments the axonal size distributions are more variable than "typical" segments. The flattening reflex is mediated by axons in SN III (Pallas and Drewes, 1981). In body segments having reconstituted behavioral characteristics of the lost tail segments, the area of the largest axons and the general size distribution in SN III approximate those found in normal tail segments.

Animals↗
PubMed1996

Reduction of the current of injury leaving the amputation inhibits limb regeneration in the red spotted newt.

Immediately following amputation of the limb in salamanders, a strong, steady, and polarized flow of ionic current is produced by the injury. Current flows in a proximodistal direction within the limb stump and is associated with a fall in electrical potential of about 50 mV/mm near the stump's end. This current is electrogenically driven by the Na(+)-dependent, internally positive transcutaneous voltage of the intact skin of the limb stump. Reduction of this EMF, the skin's battery, by topical application of Na+ blocking agents leads to inhibition or disruption of normal limb regeneration. This suggests electrical factors are a critical control of limb regeneration. Here we test another means to reduce the injury current and its associated electrical field within the forelimb stump of red spotted newts. A fine (40 gauge), insulated, multistrand wire was inserted beneath the skin of the animal's back, with the uninsulated portion terminating either at the shoulder region or at the base of the tail. When this cathodal (negative) electrode is connected to a regulated current source, sufficient current was pulled into the stump end from an external anode (placed in the water the animal was immersed in) to markedly reduce or null the endogenous current for the first 8 days following amputation. The extent of limb regeneration in sham-treated and experimentally treated animals was determined 1 month following amputation at the elbow. Sham-treated animals regenerated normally, with most producing digits within this time. Limb regeneration was completely arrested, or caused to be strikingly hypomorphic, in half of the experimentally treated animals. This effect was independent of where the subcutaneous electrode was placed and suggests that electrical (physiological) factors are indeed a critical control of limb regeneration in urodeles.

Animals↗
PubMed1980

[Inversion versus amputation of the appendix: an objective comparison of 440 randomized cases (author's transl)].

Normal or scarred appendixes may be removed by amputation or inversion. Inversion is appealing for its high degree of asepsis, but criticized for the possibility of organ retention with consecutive invagination. The risks and advantages of amputation appear to be exactly the opposite. For objective comparison, a prospective study was undertaken, using both procedures in 400 cases of solitary and 40 cases of complementary appendectomies at a random number key. Wound infection was observed in 0.5% following inversion, in 8% following amputation as a solitary procedure. Both methods were equally followed by wound infections which performed as complementary procedures. However, inversion was free of enterogenous infection in all cases. Technical precautions were taken to facilitate sloughing of inverted appendixes. No clinical symptoms indicating retention or correlated complications were observed.

Adolescent↗
PubMed1994

Radical forequarter amputation with hemithoracectomy and free extended forearm flap: technical and physiologic considerations.

BACKGROUND: A radical forequarter amputation with partial chest wall resection (one to four ribs) has been reported for benign and malignant lesions involving the shoulder and chest wall region. Concerns about reconstruction and postoperative pulmonary function have previously limited more extensive chest wall resections. The current report describes the first case in which a complete unilateral anterior and posterior chest wall resection and pneumonectomy (hemithoracectomy) accompany a forequarter amputation. A novel reconstructive technique used the full circumference of the forearm tissue with an intact ulna as a free osseomyocutaneous flap. METHODS: In this case, a 21-year-old patient presented with an extensive recurrent desmoid tumor that involved the shoulder, brachial plexus, subclavian vein, and chest wall from the lateral sternal border to the midportion of the scapula and down to the eighth rib. The operative technique involved removal of the entire right hemithorax from the midline sternum to the transverse process posteriorly, down to the ninth rib inferiorly. Due to the absence of a rigid hemithorax, the uninvolved ipsilateral lung was also removed. The forearm flap was prepared before final separation of the specimen and division of the subclavian vessels. RESULTS: Postoperatively, the patient maintained excellent oxygenation without atelectasis or fever and was extubated on the 15th postoperative day. As expected after pneumonectomy, significant decreases from preoperative to immediate postoperative values were noted for the vital capacity (VC) (from 4.87 L to 1.29 L), forced 1-s expiratory volume (FEV1) (from 3.77 L to 1.02 L), and inspiratory capacity (IC) (3.33 l to 0.99 l). Rehabilitation included a specially designed external prosthesis to provide cosmesis and prevent scoliosis. By the 15th postoperative week the patient had returned to normal social and physical activities, with a gradual improvement in all respiratory parameters: VC 1.52 L, FEV1 1.29 L, IC 1.04 L. There has been no evidence of tumor recurrence at 1 year. CONCLUSIONS: This report provides evidence that a complete hemithoracectomy, pneumonectomy, and forequarter amputation can be safely performed for selective tumors involving the shoulder region with extensive chest wall invasion. Reconstruction may be achieved with an extended forearm osseomyocutaneous free flap with an excellent functional outcome.

Adult↗
PubMed2005

Transmetatarsal amputation: three-year experience at Groote Schuur Hospital.

Transmetatarsal amputation (TMA) for peripheral vascular disease has the reputation of being an operation with a poor outcome. This retrospective study reviewed a 3-year consecutive series of TMA in diabetic and nondiabetic patients. All amputations performed for peripheral vascular disease at Groote Schuur Hospital from January 1999 to December 2002 were reviewed. Data were obtained from hospital records and operating theatre books. The following groups were defined for the purpose of this retrospective study: group 1, TMAs performed in diabetic patients; group 2, TMAs done in nondiabetic patients. Altogether, 43 TMAs were performed: 27 in group 1 and 16 in group 2. Perioperative mortality rates were 7% and 4%, respectively. Overall, the healing rate was 67%: 62% (17/27) in group 1 and 75% (12/16) in group 2. The median times to healing were 8 months in group 1 and 7 months in group 2. Toe pressure and the presence of advanced tibioperoneal disease influenced the outcome of TMA in diabetic patients. Transmetatarsal amputation with a healed stump provided our patients with good mobility. Prediction of healing after operation is unreliable. There was no statistical difference in outcome in diabetic (group 1) versus nondiabetic (group 2) patients.

Adult↗
PubMed2003

Surgical anatomy of the lateral supramalleolar flap in arteritic patients: an anatomic study of 24 amputation specimens.

The lateral supramalleolar flap (LSMF) is frequently used for covering major tissue defects of the foot and ankle but usually, in case of arteriopathy of the lower limbs, this device is contra-indicated. Twenty-four specimens of amputated limbs of patients suffering from arteriopathy of the lower limbs allowed us to study the vascular anatomy of this flap after intra-arterial injection of colored latex. At the time of the amputation the average age of the patients was 68.5 years. The clinical signs of arteriopathy had been present for 3-16 years. In 10 cases the amputation was performed directly, in 14 cases after an unsuccessful attempt at revascularization. The dissection results revealed certain specificities in the vascularization of the LSMF with arteriopathy. The perforating branch of the peroneal artery was found in all cases. The descending branch of this perforating artery was found to be patent in 22 cases but slim in five cases. It was absent in two cases. The superficial peroneal nerve and its vascular network always participated in the vascularization of the flap. Thus, its preservation in the distal part of the flap offers a second vascular flow to the pedicle of the LSMF. This specificity increases the theoretical feasibility of the LSMF from 17 to 22 cases out of 24 in our dissections. The authors suggest a theory according to which the evolution of arteriopathy and the gradual concomitant development of a supply network, which effects the vascularization of the sensory nerves too, induces the "anticipation" of a flap. The preliminary distal revascularization by bypass grafts or by some kind of endovascular treatment should guarantee the good vascularization of a limb and the reliable use of this neurocutaneous arterial network.

Aged↗