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Partial regeneration of the above-elbow amputated rat forelimb. I. Innate responses.

Although a number of recent studies describe the facilitation of limb regeneration by electrical and other forms of stimulation, little is known of innate regenerative capacity in the mammalian limb. The present report describes spontaneous regenerative responses following subtotal forelimb amputation in the young white rat. In one group of animals the forelimb was amputated through the lower humerus and the skin sutured closed. In a second group, adjacent muscle tissue still attached to bone at its origin(s) was interposed between the cut surface of the humerus and the skin. Among animals of the first group (skin closure only) bone growth and limb regenerative responses were generally not observed. Animals of the second group displayed significant elaborations of cartilage and bone at the limb terminus. The appearance and subsequent modification of these tissues suggest that some capacity for limb regeneration exists innately in the young rat and can be more readily evoked than has been recognized heretofore. It is concluded that extant and forthcoming reports of electrically stimulated skeletal tissue growth, repair and regeneration among eutherial mammals should be examined to determine whether reported responses to stimulation represent advances beyond what might be expected from innate replacement processes alone.

Amputation, Surgical↗

Forequarter amputation for recurrent breast cancer: a case report and review of the literature.

Axillary recurrence of breast cancer is an uncommon event that can lead to debilitating pain, lymphedema, and paralysis of the upper extremity. Multimodality therapy including surgery is usually used to control local recurrence. In a subset of patients, the extent of disease is such that local excision of the recurrence is not possible. In the absence of metastatic disease, forequarter amputation may be used as an effective means of surgical salvage and palliation for locally recurrent breast cancer. In this report, we describe management of a patient with advanced axillary recurrence treated with forequarter amputation and review the current literature on the use of this operation in breast cancer patients.

Amputation, Surgical↗

The technique of major amputations for malignant tumors.

Major amputations for malignant tumors have declined in incidence due to limb salvage procedures using combinations of modalities. For extensive malignant growths, amputations are still necessary and life-saving operations. Familiarity with the anatomy and technique involved is important. In the following, technical details related to these operations and their variants are provided.

Adult↗

Microsurgical replantation of an incompletely amputated penis.

The use of microvascular techniques in the replantation of one partially amputated penis is presented. The advantages of these techniques are discussed. A review of the literature is included; penis-replantation results prior to the introduction of microvascular techniques are compared to results achieved since the advent of these techniques. The superior results associated with microsurgical techniques are demonstrated, and it is concluded that microsurgical replantation is the procedure of choice in the repair of penis amputations.

Amputation, Traumatic↗

Replantation of a multiple digit and circular palm amputation: a case report.

A case of successful replantation of multiple digits and circular palm amputation caused by an industrial punch force is reported. The two-level amputation was reconstructed by first replanting the severed fingers to the palmar segment and then connecting the palm segment to the hand stump. An arterial crisis was treated with urokinase, and postoperative functional recovery is described.

Adult↗

Salvage of a through-knee amputation level using a free fillet of sole flap.

A young adult male sustained a compound crural fracture with a 15 cm defect of tibia and fibula, and an extensive soft-tissue loss of the lower leg and knee joint. A free fillet of sole flap was raised on the amputated foot and transferred to the soft-tissue defect around the femoral condyles in order to prevent an above-knee amputation. Intact vascularisation and sensation of the flap were secured by microsurgical anastomoses of the popliteal and posterior tibial vessels and the sciatic and tibial nerves. The patient was rehabilitated rapidly with a prosthesis. At the 12-month follow-up, he demonstrated excellent "foot" sensibility, stable soft-tissue coverage of the stump, and an optimal functional result.

Accidents, Traffic↗

Replantation of amputated facial tissues with microvascular anastomosis.

A challenge to the microsurgeon is perfecting the technique of replantation of small pieces of facial tissue, mainly because of the extremely small size of the arteries as well as a lack of suitable veins for drainage. In the past 4 years, we have had seven cases of facial amputations, which included one scalp, two nasal tips, two ears, one lower lip, and one eyebrow. All of these patients were replanted/revascularized by microvascular anastomosis. Only two of the cases had suitable veins for anastomosis. Alternative techniques used for improving venous outflow were arterio-venous fistula, chemical leeches, and pin pricks. Four of the cases were completely successful, two cases had partial loss of the replant, and one case failed due to absence of venous drainage. In facial amputation, an aggressive microsurgical attempt will result in more tissue surviving and a better cosmetic outcome than in any other reconstructive procedures.

Adult↗

Antihypertensive drug therapy and the risk of lower extremity amputations in pharmacologically treated type 2 diabetes patients.

PURPOSE: The objective of this study was to determine the association between different antihypertensive drug therapies and lower extremity amputations (LEAs) in type 2 diabetes patients. METHODS: Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and data on hospitalisations for all 450,000 residents of eight Dutch cities. In a nested case-control study among 12,140 type 2 diabetes patients who used antihypertensive drugs, 26 cases with a first LEA and 94 controls without a LEA matched on age, sex and calendar time were identified. Logistic regression was used to estimate the relative risk of LEA and to adjust for potential confounding factors. RESULTS: Among type 2 diabetes patients who used antihypertensive drugs, subjects who used thiazide diuretics, alone or in combination, had a higher risk of LEA compared to subjects who used Angiotensin Converting Enzyme (ACE) inhibitor monotherapy (crude odds ratio (OR): 6.11 [95% confidence interval (CI): 1.32-28.27]). The use of thiazide diuretics was also associated with an increased risk of LEA when compared to the use of any non-thiazide antihypertensive drug (adjusted OR: 7.04 [1.10-45.30]). The increased risk of LEA associated with the use of thiazides compared to the use of non-thiazides depended on the duration of use (adjusted OR(< or = 365 days), 4.82 [0.61-38.34] and adjusted OR(>365 days), 26.16 [1.02-674.02], p-trend = 0.01). CONCLUSIONS: Treatment with thiazide diuretics compared to treatment with other antihypertensive drugs was associated with excess amputations in type 2 diabetes patients. Due to several limitations of this study, our findings do not preclude the use of thiazides in type 2 diabetes mellitus patients as yet.

Aged↗

[Amniotic amputation (author's transl)].

This report is upon a new-born child whose intra-uterine amputated right hand was found in the placenta. Besides there was a syndactylism together with the missing of the middle and end phalnges of the long fingers of the left hand. Individual observations have been reported and the question of exogenous or endogenous causes for the so-called amniotic amputation is being discussed.

Amnion↗

A case of multicentric synchronous osteosarcoma treated with a vascularized tibia graft from an amputated limb.

A 10-year-old girl with synchronous lesions of osteosarcoma in the left proximal tibia and in the right distal radius but with no lung metastasis was treated by an innovative procedure. After an above-knee amputation and a wide excision of the distal halves of the radius and ulna, the skeletal defect of the forearm was replaced by the distal tibia harvested from the amputated leg using the microsurgical technique of revascularization. The result was encouraging up to the point of her death due to other, widespread lesions.

Amputation, Surgical↗

Antibiotic prophylaxis in lower-extremity amputations due to ischemia. A prospective, randomized trial of cephalothin versus methicillin.

The efficiency of prophylactic antibiotic therapy in amputation surgery was studied in a prospective, randomized trial of a first-generation cephalosporin (cephalothin) compared with a narrow-spectrum beta-lactam stable penicillin (methicillin). Eighty-eight patients received cephalothin 2 g X 4 on the day of operation, while 86 patients received methicillin 1 g X 4. The patients were followed up for 21 days. Infected wounds occurred in 14.8% of the patients in the cephalothin group, compared with 14% in the methicillin group. The frequency of deep infections was 10.2% versus 4.7% (P = 0.1611). The reamputation frequency was 18.2% in the cephalothin group compared with 12.8% in the methicillin group; the frequency of below-knee reamputation was 18.4% versus 7.7% (P = 0.1469). No clostridial infections were found. The study did not demonstrate any significant difference between cephalothin and methicillin in the prophylaxis for lower-extremity amputations, although the latter drug tended to be the best choice.

Adult↗

Amputation of the little finger.

We review 17 patients who had 21 amputations of the little finger. Transmetacarpal amputations gave satisfactory results in older patients, but in young patients loss of breadth of the palm caused significant disability. Disarticulation through the metacarpophalangeal joint is recommended in younger patients.

Age Factors↗

Gas-producing infections after lower-limb amputation because of ischemia.

During the period 1972-1982, 22 patients with gas-producing infections after lower-limb amputation because of ischemia were reviewed. In 16 cases bacteria of the genus Clostridium could be cultured. Treatment consisted of hyperbaric oxygen, surgical debridement, and antibiotics. The incubation period was 1-11 days after the primary amputation, and the duration of the infection 2-31 days, significantly lower among 14 patients with diabetes mellitus. There was no difference in the course of clostridial and nonclostridial infections. No deaths were attributable to gas-forming infection.

Aged↗

Endoscopic revision of an infected Syme amputation. Case report and review of the literature.

Arthroscopic revision of intra-articular infection is more and more accepted. To our knowledge, there is no description of endoscopic management of an infected amputation stump. This paper presents the case of a 54-year-old man after a Syme amputation of his left leg because of diabetic gangrene of the foot. A local infection of the stump was treated successfully with two endoscopic debridements and lavage. Additionally, the patient received local antibiotics by the application of antibiotic collagenous fleece and chains. This therapeutic management combined with early weight-bearing produced a stable stump.

Amputation Stumps↗

[Amputation involving the hand: indication and technique (author's transl)].

More than 3% of all work-related hand injuries result in partial or total amputation of fingers or hands (of 14621 patients with hand injuries, 479 patients had 878 amputations). When there is no possibility or indication for microsurgical replantation, the aim of the surgical effort is to rebuild a sensitive, vigorous grasp. The different procedures for plastic surgery of the hand are discussed.

Accidents, Occupational↗

[Reconstructive surgery of knee para-articular amputation stumps].

Reconstructive plastic procedures in primary care and in postprimary/secondary treatment following below knee and above knee amputation are discussed. Short amputation stumps and stumps suffering from insufficient soft tissue coverage should be primarily avoided employing salvage replantation techniques. Secondarily conventional flaps and grafts, tissue expansion and/or microsurgical free tissue transfer all serve for achieving stable skin conditions and preserve adequate stump lengths. Interdisciplinary treatment racionale will lead to improvement of functional and social rehabilitation.

Adolescent↗

[Coping with illness and psychotherapy for patients after amputation].

Psychology is often neglected or glossed over in most works dealing with the rehabilitation of the amputee. Treating the psychological and social problems faced by the amputee often has more significance for his-satisfaction with life than the quality of the surgery or the nature of his prosthetic device. In the following paper, a complex model for the biopsychosocial adaptation after amputation is presented. In this model, the important diagnostic criteria in interaction with specific individual coping strategies are formulated, which explain the difficult psychosocial adaptation. Professional diagnosis and further indication are necessary on an individual basis. The main goal of every intervention is the psychic stabilization of the patient by taking into account his personal resources. Because of the complex somatic, social, and psychic problems which arise after an amputation, thorough cooperation between specialists is recommended.

Adaptation, Psychological↗

Input-increase and input-decrease types of cortical reorganization after upper extremity amputation in humans.

A plastic remodeling of regions in somatosensory cortex has previously been observed to occur in separate experimental paradigms in response to loss of somatosensory input and to increase in input. In this study, both types of cortical reorganization have been observed to occur concurrently in the same adult human nervous system as a result of a single intervention. Following upper extremity amputation, magnetic source imaging revealed that tactile stimulation of the lip evoked responses not only in the area of the somatosensory cortex corresponding to the face, but also within the cortical region that would normally correspond to the now absent hand. This "invasion" of the cortical amputation zone was accompanied by a significant increase in the size of the representation of the digits of the intact hand, presumably as a result of an increased importance of sensory stimulation consequent to increased dependence on that hand imposed by the loss of the contralateral extremity.

Adolescent↗