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PubMed2003

Lengthening of the amputation stumps of the distal phalanges using the modified Ilizarov method.

PURPOSE: The purpose of this study was to introduce the technique for distraction lengthening of the traumatic amputation stumps of distal phalanges less than 10 mm long by using the Ilizarov minifixator (Ito Medical Instruments, Tokyo, Japan) and to report the treatment results and the problems we encountered. METHOD: Six patients (3 men and 3 women) underwent lengthening of the traumatic amputation stumps of distal phalanges using the Ilizarov minifixator. The mean pre-operative length of the distal phalanges was 6.0 mm and the mean deficiency in length was 9.5 mm compared with the contralateral finger or thumb. RESULTS: In 5 of the 6 patients callus lengthening was completed without early consolidation or bone failure related to the traction wires. The mean gain in lengthening of the distal phalanx was 6.8 mm and the mean final length of the distal phalanx was 12.8 mm. After surgery 4 patients had onychoplasty and advancement flap coverage of the distal phalangeal tip because of excessive skin tension and 1 patient had arthrodesis because of flexion contracture of the distal interphalangeal joint. The patients were satisfied with the cosmetic improvement of their fingertips. CONCLUSIONS: Although this callus distraction method required multiple surgical procedures it is considered worthy of more frequent application especially in young patients.

Adult↗
PubMed2001

[Revascularization of the profunda femoris artery in ischemia of the stump after above knee amputation].

We describe a severe complication after above knee amputation: persisting ischemia of the stump, and its treatment by vascular surgery. Only 4 (2.3%) of 168 above knee amputations performed in our department between June 1985 and September 1999 were followed by ischemia of the stump non responding to conservative treatment. We decided on subsequent revascularization of the ipsilateral deep femoral artery. A femorofemoral bypass graft was successfully implanted. A reamputation or an exarticulation of the hip joint could be avoided. We call special attention to the importance of the deep femoral artery.

Aged↗
PubMed2004

Thoracodorsal artery perforator (TAP) flap reconstruction of a soft-tissue defect of the knee following below-knee amputation.

Soft-tissue coverage of lower extremity defects with thin, sensate, mobile, and durable soft tissue is challenging. Reconstructive options are further limited in the setting of a below-knee amputation. The authors present the first report of an innervated thoracodorsal artery perforator (TAP) flap for coverage of an anterior knee soft-tissue defect in a patient with bilateral below-knee amputations following disseminated meningococcemia. The soft-tissue defect measured 11 x 17 cm2 centered over the patella, and the TAP flap provided adequate pedicle length, with optimal soft-tissue thickness and pliability with the potential for innervation and minimal donor-site morbidity. Six months postoperatively, the patient is ambulating well with prostheses fitted over her well-healed, stable, knee coverage.

Adult↗
PubMed1990

[Transmetatarsal border zone amputation in arterial blood supply disorders].

Transmetatarsal amputations (TA) were performed in 32 patients (22 men, 10 women; mean age 64 [40-91] years) with occlusive arterial disease. Previous revascularization procedures (bypass, thrombendarterectomy, embolectomy) had been performed in 26 patients. Surgical results of TA after one year were good in 16, satisfactory in seven, and unsatisfactory in nine. Further amputations became necessary after a mean of 52 (4-221) days in four of the six patients without and five of 26 with previous revascularization. Follow-up examination 1-6 years after discharge found that six had died, 16 were able to walk and fully rehabilitated, while in ten walking was limited and they required help in walking.

Adult↗
PubMed2005

Functional results after a Krukenberg amputation.

This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right transradial amputation where eventually a Krukenberg procedure was performed, is described as is its good functional outcome after rehabilitation treatment. After this first procedure the patient also asked for the Krukenberg procedure for her left arm.

Activities of Daily Living↗
PubMed1999

Fluorodeoxyglucose PET in the evaluation of amputations for soft tissue sarcoma.

The aims of this study were to evaluate the uptake of fluorodeoxyglucose (FDG) in the stumps of patients who have had amputations for soft tissue sarcoma and assess its utility in identifying local recurrence of disease. Sixteen patients who had either an upper or a lower limb amputation were evaluated. FDG PET scans (half body scans to the stump +/- local emission transmission views of the stump) were performed as part of their routine follow-up for evidence of metastases over a number of years (mean = 2.6 years; range 0.25-8 years). Diffuse uptake was found in 10 stumps for up to 18 months post-surgery without any evidence of disease recurrence. Focal areas of uptake were associated with known pressure areas with skin breakdown that could be seen clinically. In the absence of localized clinical changes, these areas represented a recurrence and needed a biopsy.

Adolescent↗
PubMed1996

Calcaneal fillet flap: a new osteocutaneous free tissue transfer for emergency salvage of traumatic below-knee amputation stumps.

Traumatic below-knee amputations do not always leave enough soft tissue of bone with which to fashion a stump of sufficient length and durability to support a prosthesis. Composite free flaps can often be harvested from the amputated limb to provide immediate one-stage stump salvage and to preserve knee function. We report a new technique to increase stump length by incorporating the calcaneus into a foot fillet flap as a vascularized bone transfer. The calcaneal fillet flap is a useful addition to the inventory of available composite flaps. It is recommended for knee joint salvage when there is less than 11 cm of tibial remnant length.

Adult↗
PubMed2005

Leg length preservation with pedicled fillet of foot flaps after traumatic amputations.

Six patients with insufficient soft-tissue coverage after lower limb trauma were treated with pedicled fillet of foot flaps to achieve primary stump closure and to preserve leg length. The flaps used were all based on either the posterior tibial neurovascular pedicle, the anterior tibial neurovascular pedicle, or both. Five flaps survived; one patient required conversion of a through-knee to an above-knee amputation and debridement of the flap because of venous thrombosis of the pedicle. In three of the cases, a functional knee joint was preserved. The patients ranged in age from 21 to 54 years, the mean hospital stay was 55.5 days (range, 28 to 76 days), and the mean follow-up time was 14.5 months. Despite an average of 4.3 procedures from initial admission to first discharge and an average of 2.0 postamputation procedures to achieve primary stump healing, all patients have achieved independent mobility with their prosthesis. The advantages of preserving leg length and, where possible, preserving a functional knee joint compensate for repeated procedures on these patients. When planned well, a pedicled fillet of foot flap therefore achieves the aims of amputation, namely, providing primary healing of a sensate, durable, cylindrical stump that is pain-free and preserves maximal leg length. This is achieved with no donor-site morbidity and with no need for microvascular reconstruction.

Adult↗
PubMed1993

Changes in sensation after nerve injury or amputation: the role of central factors.

Dynamic changes in somatosensory cortical maps are known to occur in experimental animals subjected to peripheral nerve transection or amputation. To study the sensory effects of central nervous system adaptation to temporary or permanent loss of input from a part of the hand, multimodality quantitative sensory tests were carried out in 11 patients with complete traumatic division and repair of the median or ulnar nerves and in six patients who had undergone amputation of one or more digits. As expected, vibration, two point discrimination, and tactile thresholds were raised in the territory of the injured nerve in a graded fashion, sensitivity being poorest in the patients with the most recent injuries. Surprisingly, localisation was better in the tips than at the base of the hypoaesthetic fingers, suggesting a central attentional gradient. Stimulus-response curves conformed to a power function whose exponent was higher in denervated than in normal skin. Changes in psychophysical functions were also discernible in the intact hand. There was no hyperaesthesia in the territory of the nerve adjacent to the injured one or in the stump in the case of amputees. Central factors contribute to the sensory changes seen after nerve injury, but the functional effects of the cortical reorganisation that follows partial deafferentation are more subtle than a simple heightening of sensitivity in the surrounding skin.

Adolescent↗
PubMed2003

The functional results of ray amputation.

Twenty patients (14 males, six females) were assessed at an average of 32 months (ten to 156 months) after ray amputation using the disability shoulder, arm, hand (DASH) questionnaire, physical examination and functional testing. There were 14 border (eight index, six little) and six central ray (five middle, one ring) amputations. Our results showed on average 27% less grip and 22% three-point pinch strength in the operated hands. Peak power output was 22% and average work output 14% less on the operated side than the contralateral hand. The DASH function score was 29.2 (range 3.3-74.2). Nine patients returned to their previous occupation, two had to change jobs and two did not return to work. Six patients were not working, one was of school age. The ensuing disability remained within limits reflected by our measurements and the acceptance of the patients.

Adolescent↗
PubMed2000

Reorganization of primary motor cortex in adult macaque monkeys with long-standing amputations.

The organization of primary motor cortex (M1) of adult macaque monkeys was examined years after therapeutic amputation of part of a limb or digits. For each case, a large number of sites in M1 were electrically stimulated with a penetrating microelectrode, and the evoked movements and levels of current needed to evoke the movements were recorded. Results from four monkeys with the loss of a forelimb near or above the elbow show that extensive regions of cortex formerly devoted to the missing hand evoked movements of the stump and the adjoining shoulder. Threshold current levels for stump movements were comparable to those for normal arm movements. Few or no sites in the estimated former territory of the hand evoked face movements. Similar patterns of reorganization were observed in all four cases, which included two monkeys injured as adults, one as a juvenile, and one as an infant. In a single monkey with a hindlimb amputation at the knee as an infant, stimulation of cortex in the region normally devoted to the foot moved the leg stump, again at thresholds in the range for normal movements. Finally, in a monkey that had lost digit 5 and the distal phalanges of digits 2-4 at 2 yr of age, much of the hand portion of M1 was devoted to movements of the digit stumps.

Amputation, Surgical↗
PubMed1979

A study of stump growth in children with below-knee amputations.

The growth of the stump has been studied in eighteen children with below-knee amputations. Measurements were available shortly after operation and later at skeletal maturity. It was found that all patients achieved less than expected growth and that the reduction was greater in those patients who had had amputation for congenital deformity.

Adolescent↗
PubMed2004

Fibular segment bone bridging in trans-tibial amputation.

The purpose of this paper is to present an alternative method of achieving a synostosis between tibia and fibula in trans-tibial amputations by means of a fibular segment in place of tibial osteoperiosteal flaps as described by Ertl, in 1949. From May 1997 through to February 2003, 15 patients were submitted to the proposed procedure. As a result, all patients produced a solid synostosis between tibia and fibula and were rehabilitated with the use of prostheses. The capacity of these patients for distal weight-bearing on the stump was remarkable when compared to patients submitted to the conventional trans-tibial amputation technique.

Adult↗
PubMed2004

A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterial insufficiency.

BACKGROUND: A multicentre randomised controlled trial to determine the effect of a rigid plaster dressing applied at the time of trans-tibial amputation on the number of days to casting for a prosthesis, and the incidence of post-operative stump infection. METHODS: Patients requiring trans-tibial amputation were randomised to one of 2 groups: In Group 1 (intervention) a rigid above-knee plaster dressing was applied at operation and patients were managed according to a standard protocol. Group 2 (control) had the individual surgeons' usual non-rigid dressing regime. Rehabilitation data were extracted from the national physiotherapy database. On completion of the trial a questionnaire was sent to all participants. RESULTS: 14 surgeons in 7 centres enrolled 154 patients, with 96 ultimately cast for a prosthesis. Patients who received a rigid dressing (n = 78) had reduced days to casting (median 36, confidence interval 30-47) when compared with other dressings (n = 76) (median 42, confidence interval 36-45), these differences did not reach statistical significance. There was no significant difference in post-operative infection rates in the two groups. 64% of surgeons, and all physiotherapists and vascular nurses responding to the post-trial questionnaire felt that the rigid dressing was an improvement on their normal regime and wished to continue with the technique. CONCLUSIONS: Despite a median reduction of 6 days in time to casting in patients treated with a rigid post-operative dressing this failed to reach statistical significance. The majority of participants who replied to the post-trial questionnaire expressed a wish to continue using the rigid dressing technique. To confirm that the trends shown in this trial are statistically valid a larger trial is needed.

Amputation, Surgical↗
PubMed1979

Knee disarticulation versus above-knee amputation.

If below-knee amputation is impossible, knee disarticulation should be considered before above-knee amputation, regardless of age and etiology. Knee disarticulation which leaves the femur and patella untoched offers many advantages. The surgical technique is simple and non-traumatic since no bone or muscle tissue is to be dissected. The thigh muscles are completely preserved and thus there is no muscular imbalance. The stump permits total end bearing and its bulbous shape permits easy and firm attachment of the prosthesis. A specially designed double-wall socket and various types of knee joints are presented. Modern prostheses are superior to above-knee prostheses with regard to function, comfort and cosmesis. Results of 72 patients of all age groups are presented and discussed.

Adolescent↗
PubMed1987

The value of revision surgery after initial amputation of an upper or lower limb.

The value of revision surgery when carried out more than six weeks after initial amputation of the upper or lower limb was assessed. When performed for stump and/or phantom limb pain alone, only 33/95 (35%) obtained satisfactory results after one revision; 25/95 (26%) of the patients required four or more surgical procedures without relief of pain. However, when carried out for local specific pathology, the results of surgical revision were 100% successful, even if the procedure had to be repeated once in 15% (28/189) of this group of patients. Transcutaneous nerve stimulation appeared to offer no long lasting relief of pain following amputation surgery.

Adult↗
PubMed1996

Painful neuromata following upper limb amputation.

Painful neuromata occurring after upper limb amputation are a significant cause of stump pain and limit the success of prosthetic training and use. There is little information in the literature regarding incidence, consequences or outcomes of painful neuromata subsequent to upper limb amputation. This article reports an analysis of thirty-two consecutive upper limb amputees. Of these 25% had moderate-to-severe stump pain and clinical signs suggestive of neuromata. All patients with neuromata were limited in their ability to use a prosthesis prior to surgery and following failure of conservative measures, were referred for surgical opinion. Six patients have undergone surgical management. The results of surgery, with respect to pain and prosthetic usage, are discussed.

Adolescent↗
PubMed1985

Muscle blood flow after amputation. Increased flow with medullary plugging.

At below-knee amputation for arterial insufficiency in 31 patients, the muscle blood flow of quadriceps and triceps surae was measured by clearance of 99mTc pertechnetate pre- and postoperatively. In 15 patients, myoplastic amputation was performed and in 16 patients the medullary cavity of the tibial stump was plugged with cortex of the removed bone as well. Plugging caused a two-third increase in muscle blood flow.

Aged↗