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At least 1,603 records · Page 89Linked to original sources
PubMed1997

Abnormal limb regeneration in the short-toes mutant of the axolotl, Ambystoma mexicanum: studies of age, level of amputation, and extracellular matrix.

Limb regeneration in the short-toes axolotl is impaired. Our goal was to characterize the regeneration process in this mutant by histological and immunocytochemical methods. Previous research indicates that age and a defective basement membrane may be instrumental factors in short-toes axolotl regeneration (Del Rio-Tsonis et al. [1992] Proc. Natl. Acad. Sci. U.S.A., 89:5502-5506). The present results show that limb regeneration can occur even in older (1-2-year-old) short-toes axolotls. The process was always significantly delayed, but the time required for complete regeneration varied. Even so, the basement membrane of short-toes regenerates showed no differences in thickness or shape compared with wild-type regenerates. Distally amputated short-toes limbs gave rise to more digits in the regenerate, indicating that regeneration may be somewhat dependent on the level of amputation. Since extracellular matrix (ECM) remodeling occurs extensively during regeneration, we compared the ECM of the short-toes and wild-type regenerates using monoclonal antibodies (mAbs) MT2 and ST1 (Tassava et al. [1996] Wound Rep. Reg., 4:75-81). The short-toes regenerates showed decreased reactivity to mAb MT2, which identifies type XII collagen, an ECM protein that is normally unregulated during regeneration, and increased reactivity to mAb ST1, which identifies a limb ECM component that typically undergoes breakdown in the distal stump. Thus, impaired regeneration in the short-toes axolotl is correlated with impaired ECM remodeling in the distal limb stump. This supports the view that ECM remodeling plays an important role in regeneration.

Aging↗
PubMed1976

Lower-limb amputation for occlusive vascular disease.

A small series of 58 patients who required amputation because of gangrene of the lower limb with nonreconstructable arteries at New York University Medical Center illustrates the manner in which application of some of these principles achieved primary healing of 78% in below-knee amputation and rehabilitation rate of as high as 90% using simple nonrigid dressings.

Adult↗
PubMed1998

Sensory changes in adults with unilateral transtibial amputation.

The purpose of this study was to describe the sensory changes in adults with unilateral transtibial amputation (TTA), as any loss of sensation may have significant impact on the successful use of a prosthesis. Sensory modalities of light touch, deep pressure, vibration, and superficial pain (pinprick) were examined on the residual and contralateral limbs of 16 veterans with TTA. Six Subjects demonstrated normal sensation on the contralateral limb and impaired sensation of superficial pain, vibration, and/or light touch on the residual limb. Superficial pain was the most frequently impaired sensation, and vibration and superficial pain sensation appeared to be age-dependent, with increased impairment observed in the elderly. Deep pressure sensation was intact in all subjects. These preliminary data suggest that although neither the amputation nor the prosthetic rehabilitation resulted in impaired deep pressure sensation, these two factors contributed to minimal impairment of light touch and vibration, and significant impairment of the superficial pain sensation.

Adult↗
PubMed1998

Replantation of the amputated nose.

OBJECTIVE: To assess the effectiveness of replantation in the treatment of nasal amputations. DESIGN: Retrospective chart review. SETTING: A university medical center. RESULTS: In no case did the replant survive completely, and in all cases revision surgery was required. However, in all cases, the resulting deformity was less than the original defect. In our pediatric patients, reconstruction with cartilage grafting and a midline forehead flap was successful and demonstrated proportionate and appropriate growth. CONCLUSIONS: It is our belief that replantation serves many therapeutic functions. At the very least, there is the psychological/emotional factor that is involved in attempting to replace a native body part that has been severed. Also, it is difficult to persuade parents and patients that the amputated tissue that has been handled with kid gloves by paramedics, maintaining its pink "alive" color, is ultimately doomed to failure. Forehead flaps and conchal cartilage grafts are more willingly accepted after a "failed" replantation than as primary reconstructions. In every instance, we believe, the ultimate defect will be smaller than the original deformity. Certainly, the need for vestibular lining reconstruction is far less. Thus, the ultimate healed defect from the replantation greatly facilitates final nasal reconstruction.

Aged↗
PubMed1980

Morbid implications of above-knee amputations. Report of a series and review of the literature.

In a retrospective review of 100 consecutive patients requiring above-knee amputation for arterial occlusive disease, the operative mortality was 15%. An additional 26% mortality occurred during a two-year follow-up period. Principal causes of death were sepsis in 54%, heart disease in 16%, and stroke in 11%. The poor prognosis of patients requiring amputation was related to progression of systemic diseases and to generalized debility among these patients.

Aged↗
PubMed1980

Popliteal artery trauma. 31 consecutive cases without amputation.

Injury to the popliteal artery is the most common cause of amputation in injured extremities. A six-year experience (1974-1979) at Cook County Hospital, Chicago, involved 31 popliteal artery injuries without amputation. Penetrating trauma was the most frequent cause of injury; however, a considerable number of blunt trauma injuries with fractures and dislocations were also present. Prolonged ischemic time was not a deterrent to successful vascular reconstruction. The recognition of compartmental hypertension and performance of fasciotomy before vascular repair were credited as major factors in our success. The use of interposition saphenous vein graft in the arterial reconstruction, repair of concomitant popliteal vein injuries, initial bone fixation of fractures with external fixators, and the performance of intraoperative arteriography were all important steps taken to ensure a 100% limb salvage.

Adolescent↗
PubMed1988

Resection of malignant bone tumors of the pelvic girdle without extremity amputation.

Fifty-three patients with malignant tumors of the pelvis ossea were evaluated for location of tumor, extent of resection, postoperative function, local recurrence, and survival. Three tumors were unresectable, 17 required a wide local excision, 27 required resection of the hemipelvis without extremity amputation (internal hemipelvectomy), and six required a classical hemipelvectomy with amputation. The incidence of local recurrence was 11.8% for wide local excision, 7.4% for internal hemipelvectomy, and 33% for classical hemipelvectomy. Survival following wide local excision or internal hemipelvectomy was 58% and 41%, respectively, at five years compared with 17% for patients undergoing classical hemipelvectomy. Patients who underwent wide local excision had good to excellent functional results. Patients requiring internal hemipelvectomy initially required ambulatory supports, but many can now ambulate independently, with a neurologically intact extremity, despite a noticeably abnormal gait.

Adolescent↗
PubMed1998

Lowering the risk of neuropathy, foot ulcers and amputations.

Peripheral neuropathy is one of the most common long-term complications of Type 2 diabetes. A population-based study in the north of England showed that 42% of Type 2 diabetic patients had clinical evidence of neuropathy. The Diabetes Control and Complications Trial (DCCT) has shown that the incidence of neuropathy in Type 1 diabetes can be reduced by over 50% with intensive therapy and optimal glycaemic control. Hyperglycaemia is believed to be a major aetiological factor in the development of neuropathy in Type 2 diabetes. Neuropathy cannot be diagnosed through history alone; therefore, careful examination of the feet for evidence of sensory loss and an assessment of the circulation must form part of the annual review of each patient. Peripheral somatic and autonomic neuropathy, together with peripheral vascular disease, are major contributing factors to the development of foot ulcers. In addition, abnormalities of foot shape (e.g. claw toes, prominent metatarsal heads) and the presence of plantar callus are signs of foot-ulcer risk. Effective patient education can reduce the incidence of foot ulceration and amputation by over 50%; therefore, all patients with a high risk of foot ulcers should be informed and, if indicated, referred for regular podiatry. The team approach to diabetic foot problems is an effective method of providing treatment for active ulcers. This should be followed by appropriate education, the provision of follow up and if indicated, suitable footwear and hosiery. Key members of the team are the podiatrist, the specialist nurse and the orthotist; medical staff may include the diabetologist and a vascular or orthopaedic surgeon. Thus, the risk of foot ulceration and amputation can be reduced by careful screening and patient education, without the need for expensive equipment.

Amputation, Surgical↗
PubMed1999

Transmetatarsal amputation of the toe: an analytic study of ischemic complications.

Transmetatarsal amputations of the toes are very common procedures, particularly involving patients with diabetes mellitus and peripheral vascular disease. A complication of these operations is the onset of gangrene of an adjoining toe, which is usually ascribed to the underlying disease. It is suggested that another explanation may be responsible for this occurrence, namely, a combination of the variability of the bifurcation of the dorsal metatarsal arteries and the operative technique. The former is either not described or has different levels in different texts. The operation in nearly all texts is a classic racquet incision, without mention of the width of the racket. The combination of an incision widely diverging from the handle of the racket is in danger of severing the dorsal metatarsal artery, its bifurcation, or the digital branch to the adjacent toe. A patient with a good blood supply may be able to salvage the situation by way of the plantar vessels, but when the vascular status is parlous, which is the case in many amputations, the adjacent digit is at considerable risk. Clinical, radiological, and anatomic evidence is presented to support this contention. Based on the above, a safer operative technique is suggested to avoid possible complications.

Amputation, Surgical↗
PubMed1998

Upper extremity salvage procedure with flow-through free flap transfer taken from the amputated part.

An alternative free flap technique in a patient presenting with an incomplete amputation in the right cubital region, resulting from a gunshot wound, is introduced. The defect area was repaired using a flow-through fasciocutaneous free flap, which, when following a cubical or popliteal region amputation, is a suitable option for revascularisation and salvage of the extremity.

Adolescent↗
PubMed1994

Responsiveness of the somatosensory system after nerve injury and amputation in the human hand.

We studied the responsiveness of the somatosensory system in humans after prolonged deprivation of peripheral input. Eight patients with traumatic transection of the median or ulnar nerve and 6 patients with amputation of a finger or hand underwent microneurography and intraneural stimulation. Bundles of nerve fibers were electrically stimulated through a microelectrode placed in the affected nerve proximally to the site of damage or in the case of amputees, in a nerve fascicle supplying the stump. During intraneural stimulation the subjects with nerve injuries reported distinct percepts in the hypoesthetic skin. Their projections were usually confined to the territory of a single or two adjacent palmar digital nerves, similar to the fascicular territories of healthy nerves in control subjects, but there was much less microneurographically recordable afferent activity than in normal subjects. In amputees intraneural stimulation evoked sensations in a phantom digit or digits in over three fourths of the fascicles studied. We conclude that (1) the somatosensory system remains able to process information from a nerve fascicle that has lost its cutaneous territory, and (2) somatosensory localization remains accurate despite the presumed central reorganization that takes place after nerve division or amputation. This lack of functional adaptation has important implications with regard to our understanding of human central nervous system plasticity.

Adolescent↗
PubMed1978

The Gritti-Stokes amputation in ischaemia: a review of 134 cases.

The results of 134 Gritti-Stokes amputations for ischaemia are presented. The mortality rate was 11% and healing occurred in 88%, reaffirming the good results already reported for this operation. The long term results are reviewed in an attempt to decide whether the most frequently cited criticisms of this procedure are justified. Stump pain and mobility of the patella were not major problems. The difficulties in fitting a suitable prosthesis are discussed and attention is drawn to the advantages of a new prosthesis that has been developed for this amputation.

Adult↗
PubMed1980

Management of the amputated thumb.

Two cases are described, one of replantation of an amputated thumb, the other of late reconstruction by toe transfer. A possible reason for the good results in thumb replantation is mentioned, and the advantages of toe transfer in thumb reconstruction are discussed. Suggestions are made as to the course of action to take when confronted with a patient with an amputated thumb.

Adult↗
PubMed1986

Major amputation compared with graft occlusion as the end point for assessing results of bypass surgery in lower limb ischaemia.

Cumulative graft patency rates calculated using graft occlusion as the end point are the standard method of presenting results of bypass surgery for lower limb ischaemia. The problems of using graft occlusion as the end point are that this is not easily documented and it gives no indication of the condition of the patient's limb after the graft occludes. The date of amputation is a well defined end point and it means treatment has failed. It is used to calculate cumulative limb salvage rates. Using the two techniques to assess different risk factors (age, calf vessel run-off, diabetes, position of distal anastomosis and hypertension), it was found that the limb salvage rate was a better indicator of patient progress. Whereas graft patency rates for diabetics and non-diabetics were similar (chi 2 = 0.8, P greater than 0.1), diabetics had a higher amputation rate and the limb salvage rate was significantly worse (chi 2 = 5.0, P less than 0.05). Cumulative survival is rarely presented in vascular series but it could be used as an indicator of the general condition of patients being selected for bypass surgery. The cumulative survival of diabetics was 23 per cent (s.e.m. +/- 12 per cent) at four years, while for non-diabetics this was 55 per cent (s.e.m. +/- 15 per cent), (chi 2 = 10.6, P less than 0.001). Diabetic patients have such different limb salvage and survival rates compared with non-diabetic patients that their results should be presented separately. A better indication of patient progress following bypass surgery is obtained if limb salvage rates and survival rates are reported as well as graft patency rates.

Aged↗
PubMed1994

Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Hawaii Study Group.

In 51 hospitals in six European countries 713 patients requiring below-knee amputation for ischaemic disease were studied prospectively. The patients were allocated randomly to receive standard postoperative treatment or standard treatment plus intravenous infusion of the prostacyclin analogue iloprost for 6 h per day over 14-21 days. Healing of the amputation stump and the need for reamputation at a higher level were similar in the two groups. Overall at 3 months 59 per cent of stumps had healed, 19 per cent of patients had required reamputation at a higher level, 11 per cent had died and the remaining 11 per cent remained with unhealed stumps. Preoperative characteristics were analysed as possible risk factors or markers for primary healing, reamputation and death. Previous arterial reopening procedures (surgical or radiological) almost doubled the chances of primary stump healing (P < 0.05). The surgeon's assessment of the likelihood of healing was wrong in 21 per cent of cases in which the operating surgeon thought that healing would probably occur and in 52 per cent of those in which it was thought healing was improbable.

Adult↗
PubMed2004

Amputation through the hip joint during the pre-anaesthetic era.

Even to the present day, hip disarticulation is one of the most radical orthopaedic operations. First carried out on the Continent in 1774 and in Britain in 1779, this procedure was only deemed necessary in circumstances where death was otherwise inevitable. George James Guthrie claimed to have undertaken the first amputation through the hip joint in which the patient survived. We describe some of these cases from the pre-anaesthetic surgical literature in which amputation through the hip joint was undertaken, and we comment on the surgical techniques used. This information is complemented by the views of certain authorities on this procedure. Many surgeons during the first half of the 19th century, including Guthrie, sought alternative surgical operations to hip joint disarticulation. The removal of the head and neck of the femur was far less traumatic than disarticulation through the hip joint, and proved an extremely effective alternative procedure for lesions involving the proximal part of the femur where there was any possibility that the limb could be saved.

Amputation, Surgical↗
PubMed2005

The factor structure of the Hospital Anxiety and Depression Scale in older individuals with acquired amputations: a comparison of four models using confirmatory factor analysis.

BACKGROUND: There has been little attention to the underlying dimensional structure of the Hospital Anxiety and Depression Scale (HADS) in analyses involving individuals older than 65 years of age despite its routine application in this age group. METHODS: The factor structure of the HADS was investigated using a sample of 680 veterans with limb amputations who were aged at least 66 years (mean 79.0, SD 5.02; range 66-92) Four models were specified and estimated using Lisrel 8.54. Model 1 specified a uni-dimensional structure. Model 2 specified a correlated two-factor model. Model 3 specified a correlated two-factor model but with cross factor loadings for item 7. Model 4 specified a three-factor model after Clark and Watson's (1991) tripartite theory of anxiety and depression. RESULTS: Models 2, 3 and 4 were found to adequately fit the data. However, on balance, model 4 was found to be a better explanation of the data than the alternative specifications. CONCLUSIONS: The results indicate that factor models for the HADS developed in younger samples are replicable with older adults, thus supporting the suggestion that the HADS structure is invariant for age. However, considering the composition of the current sample, i.e. veterans with limb amputations, further research is necessary to determine whether these findings are generalisable to the wider population of older adults.

Aged↗
PubMed1985

Retention of lateral motor column neurons during the phase of rapid cell loss after limb amputation in Rana pipiens tadpoles.

Target tissue regulation of naturally occurring neuronal death during development has often been studied by removing a limb bud and then analyzing spinal motor neuron number later in development. The present study focuses on the necessity for limb presence in the initiation of the most rapid phase of cell loss from the lateral motor column (LMC) and in the control of neuron number during this restricted developmental period. Unilateral hindlimb amputation in larval Rana pipiens at the time of onset of rapid LMC cell loss resulted in an unequal, bilateral retention of excess motor neurons (i.e., less cell loss than normally occurs) during this phase. Limb traumatization, with axotomy, also resulted in reduced bilateral LMC cell loss, although to a lesser extent than did amputation. Absence of the limb or axonal transection presumably prevents the communication of motor neurons with their differentiating targets and thus interferes with the flow of information required for the selective events of neuronal loss and survival. The presence of the limb with intact axons is essential at the time that LMC cell loss normally ensues for both the initiation and progression of the phase of greatest cell loss.

Amputation, Surgical↗