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Prosthetic management of a Chopart amputation variant.

The history and prosthetic difficulties of a patient with an unusual Chopart amputation variant have been presented. Although it is possible for the Chopart amputee to walk with just a shoe and filler, this patient does best with a formal prosthesis. The Chopart amputation, which has been surgically stabilized with Achilles tendon lengthening to prevent equinus contractures, can be fitted successfully with a lightweight circumferential plastic or silicone prosthesis or more traditionally with a solid ankle foot orthosis with filler. This partial foot prosthesis is worn with a sturdy shoe with a rocker and solid ankle cushion heel or a well constructed running shoe. The Chopart amputee with equinus contractures must be fitted with a Chopart clamshell prosthesis or solid ankle patellar tendon bearing orthosis with filler and the above shoe prescription. Recent variants of the partial foot prosthesis including the Imler partial foot prosthesis, the Lange silicone prosthesis, and the ankle corset prosthesis were described.

Adult↗

The healing of amputation wounds.

This article discusses the anticipated healing of amputation wounds and highlights potential problems and actions in the pre- and post-amputation phases.

Amputation, Surgical↗

Boyd and Syme ankle amputations in children.

The Syme and Boyd amputations at the ankle were compared in thirty-four children followed for three to sixteen years. Good results were found with both techniques. The best results occurred when the heel pad was aligned in the plantigrade position, which produced almost normal function of the heel pad. The Boyd technique was a surer method of obtaining such alignment but was technically more difficult. Both the Boyd and Syme techniques are recommended for ankle amputation in children, but a distinct advantage of one technique over the other could not be defined.

Adolescent↗

Transfemoral amputation. Biomechanics and surgery.

The technique of transfemoral amputation has evolved during the last decade whereby muscle stabilization and biomechanical principles have gained new significance. Maintenance of the femoral shaft axis close to normal can be achieved by preservation of the adductor magnus and by myodesis of the muscle to the residual femur. By following established biomechanical principles, and satisfactory surgical techniques, patients undergoing transfemoral amputation are easier to fit with a prosthesis and more likely to remain able to ambulate. Reduction in stump problems can be achieved, and improvement in stump strength is seen.

Adult↗

Amputation through the knee for the nonambulatory patient.

The first amputation through the knee to be done in the United States was performed 150 years ago. Since then, its advantages have been noted repeatedly, but widespread acceptance has never been attained. Amputation through the knee should be the procedure of choice for the poor risk, bedridden patient because it is simple, safe and swift. There is minimal postoperative pain, and the stump is sufficiently long to be a useful appendage.

Amputation, Surgical↗

Traumatic amputations. A vietnam experience.

Ninety-two acute combat amputations were performed in 70 casualities of the Vietnam conflict. In the 67 surviving patients with 83 stumps, primary closure was done in 24 limbs (30%) and delayed closure in 11 more. Closed cases were observed 2 weeks and no failures noted. In selected patients early suture of war amputations can be practiced with a satisfactory result.

Adolescent↗

Postoperative dressing and management strategies for transtibial amputations: a critical review.

Postamputation management is an important determinant of recovery from amputation. However, consensus on the most effective postoperative management strategies for individuals undergoing transtibial amputation (TTA) is lacking. Dressings can include simple soft gauze dressings, thigh-high rigid cast dressings, shorter removable rigid dressings, and prefabricated pneumatic dressings. Postoperative prosthetic attachments can be added to all but simple soft dressings. These dressings address the need to cleanly cover a fresh surgical wound, but not all postoperative dressings are designed to facilitate the strategic goals of preventing knee contractures, reducing edema, protecting from external trauma, or facilitating early weight bearing. The type of dressing and management strategy often overlap and are certainly interrelated. Current protocols and decisions are based on local practice, skill, and intuition. The current available literature is challenging, and difficulties include variations in healing potential, in comorbidity, in surgical-level selection, in techniques and skill, in experience with postoperative strategies, and with poorly defined outcome criteria. This paper reviews the published literature and compares measures of safety, efficacy, and clinical outcomes of the various techniques. Analysis of 10 controlled studies supported only 4 of the 14 claims cited in uncontrolled, descriptive studies.

Amputation, Surgical↗

[Late results of patients with amputation of the thigh (author's transl)].

111 patients with amputation of the thigh of the last world war were examined. Besides the complaints in their thigh they suffered mostly from low back pain and osteoarthritis in the knee of the other leg. For a medical report it is important to decide whether the low back pain comes from lumbar disc disease or from secondary scoliosis of the lumbar spine which is caused by the amputation. Secondary changes in the spine and in the other leg can also be expected when a lower limb is heavily injured.

Aged↗

Amputation stump lengthening with the Ilizarov technique. A case report.

It is often difficult to create a functional stump from a traumatic amputation, especially in a child. A case is described of a traumatic, high, below-knee amputation in a five-year-old child. The resulting stump was too short to allow a conventional below-knee prosthesis, decreasing gait efficiency. The Ilizarov technique was used to increase tibial length. Bony lengthening was very successful, but several problems were encountered with the soft-tissue reconstruction. This technique of stump reconstruction holds promise only if the soft-tissue problems are anticipated. The suggestions for future stump-lengthening procedures are preparatory plastic surgery for skin requirements including infection prevention measures.

Amputation Stumps↗

[Lower leg amputation--vascular surgery aspects].

Of 2,816 arterial reconstructions performed between 1984 and 1988 at the AK Hamburg, 341 amputations were necessary. Only 32 lower-leg amputations were possible. Although all facts indicate that the knee joint is best preserved, it is not always possible due to underlying arteriosclerosis. If a well-vasculated dorsal skin-patch can be formed, the operation is surgically unproblematic.

Amputation, Surgical↗

[Medical rehabilitation of patients after amputation of the leg in sarcoma].

An analysis of data of 348 patients with malignant tumors of soft tissues has shown that 128 of them had been subjected to the amputation of extremities at different levels. The use of microsurgical techniques favours the improvement of the method of amputation of lower extremities, in particular the transplantation of a calcaneoplantar flap onto the stump end. In order to make the treatment of phantom limb pains more effective acupuncture should be included into the complex of therapeutic measures in addition to traditional methods. Close contacts with prostheses-makers can facilitate earlier prosthesis which can give positive effects on the following rehabilitation of such patients.

Adult↗

Prosthetic rehabilitation in bilateral high above elbow amputation.

Rehabilitation in patients with bilateral high above elbow amputation presents a considerable prosthetic problem. A patient with high upper arm amputations after a high-voltage injury is presented. He was successfully fitted with multifunctional myoelectric hand prostheses. The problems in rehabilitation of adult bilateral arm amputees are discussed and the value of fitting these patients with electrically powered prostheses is assessed. The balance between technical and clinical aspects is discussed in relation to patient acceptance. In our case good acceptance and functional benefit was noted. The fact is stressed that the bilateral upper extremity amputee can regain considerable physical function with the fitting of suitable prostheses, even if the limb remnants are short and provide little or no function. An extensive team approach at specialized centres will favour the results.

Adult↗

[Femoro-crural reconstruction in preference to amputation (author's transl)].

22 cases of arterial occlusion below the branching of the popliteal artery and 1 case of traumatic subtotal amputation of the calf were revascularized by autogenous femoro-crural vein bypasses. All patients had pain at rest and/or gangrene. So far, with an average bypass patency of 15 months in two of three equal parts of the operated legs, the decision to try reconstruction instead to amputate has met with successful results. The operative technique is described in detail and the speical problems of this group of patients and the particular difficulties of this technically sophisticated bypass procedure are discussed.

Adult↗

A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease.

A modified technique for performing the Gritti-Stokes amputation is described and the results obtained in 247 cases are presented. The mortality rate was 9.3% and healing occurred in 87% of survivors. Using this modified technique the frequently cited criticisms of non-union of the patella and painful stumps were not found to be major problems. The prosthetic problems of amputation at this level are discussed in relation to recent developments in the design of artificial limbs.

Adult↗

Combined free flap, Ilizarov lengthening and prosthetic fitting in the reconstruction of a proximal forearm amputation--a case report.

A composite free latissimus dorsi musculocutaneous flap combined with Ilizarov lengthening was used in the resurfacing of the elbow and the reconstruction of the forearm following a very proximal below elbow amputation with soft tissue degloving to the level of the mid arm. The free flap provided gliding soft tissue to the elbow joint, and the deep fascia and muscle components of the flap were contoured round the bony stump so as to allow bone transport within the soft tissue envelope. The lengthening achieved was 14 cm with no bone resorption at the end of the stump. The reconstructed forearm, with a well-contoured stump covered with durable and adherent soft tissue, allowed the fitting of a forearm-based lightweight hand glove prosthesis. With the combined modalities of microsurgical free tissue transfer, the Ilizarov method of slow distraction and prosthetic fitting, we were able to achieve restoration of both form and function in a difficult case of major upper extremity amputation.

Adult↗

Should chemical sympathectomy precede below knee amputation?

Lumbar sympathectomy has a controversial place in the management of severe limb ischemia for limb preservation. In a consecutive clinical series laser Doppler (LD) blood flow was measured at the distal limit of an anterior below knee skin flap in 21 patients. Amputation level was selected by clinical judgement. Mean LD value in 15 patients who had primary BK healing was 42V (range 20-85) compared to 11V (9-20) in six patients who proceeded to AK amputation (p < 0.001) establishing 20V as a critical value for BK healing. To examine the effect of chemical sympathectomy 21 further patients with severe ischemia had LD measurements at the same BK site before and one week after chemical sympathectomy. LD values rose significantly from 26V (10-75) to 50V (10-100), (p < 0.001). In particular seven patients had initial LD levels below 20V and in five chemical sympathectomy produced elevation to levels commensurate with BK healing. We conclude that chemical sympathectomy can improve below knee skin blood flow and may enhance primary wound healing.

Aged↗

Factors affecting healing of below knee amputation.

Between January and December 1992, 54 diabetic patients with 60 below knee amputations performed in the Department of Orthopaedic Surgery O, Singapore General Hospital were available for evaluation. The average follow-up period was 16.3 months with a range of 13 to 24 months. Five patients had stump necrosis and above knee amputation was performed. Eight patients had partial stump necrosis and required debridement with or without secondary procedures. The other patients had uneventful stump healing which was defined as healing of the stump wound without complications and remained intact for at least 6 months after surgery. Absence of popliteal pulse, presence of central cardiovascular disease and absence of intraoperative skin flap bleeding were found to be associated with higher incidence of stump necrosis.

Adult↗

[Amputation of a lower extremity. Nursing care].

Explored here are the types of nursing interventions that have been used for patients with lower limb amputations. A general discussion of why amputations are performed, as well as types and levels, is presented. The phases of pre-op., post-op., and discharge are explained, with special emphasis on patient positioning and prosthesis care.

Amputation, Surgical↗