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PubMed1986

Double level amputation: should it be replanted?

Multiple level amputation has been described as a contraindication to replantation. This is a case report of a patient with a double level amputation through the palm and forearm that was successfully replanted. Because of the need for multiple stages of reconstructive surgery, it was not clear until the end result that the replantation was worthwhile. The patient developed an acute respiratory distress syndrome that was probably caused by the reperfusion phenomenon. The stages of reconstruction are described in detail, as are the problems encountered. The final result included a reasonably functional hand that was far superior to the prosthetic alternative.

Amputation, Surgical↗
PubMed1985

Replantation of a transmetacarpal amputation. A case report.

A case is presented of a 23-year-old male who sustained a traumatic transmetacarpal amputation of his nondominant hand. The injury consisted of complete severance of structures distal to the midpalm. Microsurgical reconstruction involved the primary repair of arteries, veins, nerves, extensor and flexor tendons, and metacarpal fractures. Skeletal reconstruction also employed a primary Swanson prosthesis for the fifth metacarpophalangeal (MP) joint. Early postoperative range-of-motion exercises were encouraged, with the achievement of a functionally capable replanted extremity. The general management of an amputation injury is also discussed, as it applies to a community hospital environment.

Adult↗
PubMed1985

Results of revascularization and amputation in severe lower extremity ischemia: a five-year clinical experience.

Aggressive revascularization of the ischemic lower extremity in atherosclerotic occlusive disease by femoropopliteal (FP) and femorotibial (FT) bypass or profundaplasty (P), as indicated, has been advocated by some authors for all patients. Others have recommended primary amputation, particularly for tibial occlusive disease. To clarify this clinical dilemma, we reviewed the results of 547 procedures performed during the last 5 years: revascularization in 375 (69%) instances and below-knee amputation (BKA) in 172 (31%) cases. Bypass procedures were used in 246 cases: FP in 155 (64%) and FT in 91 (37%). Reversed autogenous saphenous vein (ASV) was used preferentially in 125 (51%) cases, whereas polytetrafluoroethylene (PTFE) was used in 121 (49%) cases. P was performed in 129 instances accompanied by inflow procedures in 92 (71%) of these cases. Cumulative limb salvage (LS) exceeded bypass patency in all categories and resulted in 2- and 5-year LS rates of 83% and 81% for FP with the use of ASV and 52% and 35% for PTFE. The LS rate for FT was 53% and 47%, respectively, for ASV and 20% and 15% for PTFE. Rest pain was successfully relieved by P in 99 cases (77%), whereas healing occurred in only 51% of cases with tissue loss. The perioperative mortality rate for revascularization was 3%; 42% of the group died during follow-up, death usually resulting from complications of atherosclerosis. Of the 172 BKAs, primary healing occurred in 80%, but the perioperative mortality rate was 13%. FP and FT bypasses are preferred procedures if ASV is available, whereas use of PTFE should be limited to FP bypasses only. Rest pain is relieved by P but tissue loss should prompt consideration for bypass. BKA should be considered in cases of severe tibial disease only in the absence of a suitable ASV, as the perioperative mortality rate is high and ultimate rehabilitation (64%) is limited.

Amputation, Surgical↗
PubMed2006

Successful microsurgical primary replantation of an amputated cheek.

Standard secondary reconstruction procedures are usually applied for the amputation of facial soft tissue, although these procedures lead to unsatisfactory results: in case of an avulsed cheek, a number of important vital cheek functions cannot be restored. More importantly, patients with artificial cheeks often face considerable psychological and social difficulties. Therefore, it appeared to be of interest to conserve soft tissue amputated from the face and to perform a replantation, despite the known problem that cheek veins cannot be re-anastomosed, especially in avulsion injuries. Here, we report a successful microsurgical cheek replantation in a 55-year-old female patient, who had lost cheek soft tissue together with parts of her mouth.

Amputation, Traumatic↗
PubMed2001

Lower limb amputation. Part 2: Rehabilitation--a 10 year literature review.

Ten years after the ISPO consensus conference on amputation surgery, a search of relevant publications in the Rehabilitation-prosthetics-literature over the years 1990-2000 was performed. The main key-words in this research were: "lower limb, amputation, human and rehabilitation". One hundred and four (104) articles were assessed by reading and from these the authors selected 24 articles. These articles are summarised, under several subheadings in this review article, focussing especially on quality of life, functional outcome and predictive factors.

Activities of Daily Living↗
PubMed2004

Strength and endurance training of an individual with left upper and lower limb amputations.

PURPOSE: The purpose of this article is to describe the development of a strength and endurance training programme designed to prepare an individual with a left glenohumeral disarticulation and transtibial amputation for a bike trip across the USA. METHOD: The subject was scheduled for training three times per week over a two-month period followed by two times per week for an additional two months. Training consisted of a resistance training circuit using variable resistance machines, cycling using a recumbent stationary bike, and core stability training using stability ball exercises. Changes in strength were assessed using 10 RM tests on the resistance machines and changes in peak VO(2) were monitored utilizing the Cosmed K4b pulmonary function tester. RESULTS: The subject demonstrated a 30.3% gain in peak VO(2). The subject's 10 RM for left single limb leg press increased 36.8% and gains of at least 7.7% were seen for all other muscle groups tested. CONCLUSION: The strength and endurance training programme adapted to compensate for this subject's limb losses was effective in increasing both strength and peak VO(2). Adapting exercise programmes to compensate for limb loss may allow individuals with amputations to participate in physically challenging activities that otherwise may not be available to them.

Adult↗
PubMedDate not supplied

A prospective study examining balance confidence among individuals with lower limb amputation.

PURPOSE: In this study we assessed whether balance confidence scores changed over a 2-year follow up period, and identified predictors of balance confidence and predictors of change in balance confidence among lower limb amputees. METHOD: A prospective follow-up survey of 245 community living adults with unilateral below and above knee lower limb amputation who used their prosthetic limb daily was conducted. Balance confidence, assessed using the 16-item Activity-specific Balance Confidence (ABC) Scale, socio-demographic, health and amputation related variables were collected at baseline and 2 years later. RESULTS: ABC scores were similar at baseline (mean = 67.6; SD = 25.7) and follow up (mean = 68.0; SD = 25.8). Lower balance confidence scores at follow up were predicted by older age, being female, use of a mobility device, poor perceived health, increased symptoms of depression, having to concentrate while walking, and fear of falling (all p < 0.05). Predictors of change in balance confidence included gender and perceived health (all p < 0.05). CONCLUSION: Balance confidence appears to be a persistent problem in the amputee population. Health professionals are encouraged to consider balance confidence as a potentially important variable that may influence function in this clinically unique group of individuals. The identified predictor variables may be useful to clinicians in targeting individuals who require attention to improve balance confidence.

Activities of Daily Living↗
PubMed1983

Amputation as a consequence of diabetes mellitus. An epidemiological review.

Amputation as a consequence of diabetes mellitus is becoming an increasingly serious public health problem and a problem that is commonly treated in the physical therapy clinic. Traditionally, physical therapists have devoted most of their efforts to treating the residual limb and have neglected caring for the other leg. This review examines the epidemiology of diabetic gangrene with consequent amputation and provides ideas for preventive measures and research directed at decreasing the occurrence of gangrene and its complications.

Age Factors↗
PubMed1983

Disseminated intravascular coagulation resulting in amputation. A case report.

This patient had many of the clinical features described in the literature as characteristic of DIC, an uncommon disease. These included the acute systemic infection precipitating the tissue pathology, ecchymotic skin lesions progressing to amputation, shock, anemia, and renal failure. The literature reported two case studies that resulted in amputation. During prosthetic training, both the patients developed skin problems that required prosthetic modification before they could wear their prostheses. The patient in our case study also required careful prosthetic modification with continual monitoring of the status of the skin. After three skin grafts and two surgical procedures to remove heteroptic ossification, the patient became a limited community ambulator (Fig. 4). When he attains full growth and the heteroptic bone formation subsides, we believe he should become a community ambulator, as long as he receives proper prosthetic care and follow-up.

Adolescent↗
PubMed1987

Prosthetic use in elderly patients with dysvascular above-knee and through-knee amputations.

Fifty-five patients with vascular insufficiency resulting in above-knee (AK) and through-knee (TK) amputations were studied to determine factors related to prosthetic candidacy and functional outcome. Chart review showed that the only difference between patients who were fitted with prostheses and those who were not fitted with prostheses was their respective number of medical complications. Twenty-three of 31 patients with prostheses were evaluated 7 to 35 months after receiving the prostheses. Ten (44%) of these patients wore their prostheses all day every day and used wheelchairs minimally or not at all. Over half of the patients evaluated used their wheelchairs most of the time. Two (9%) of the 23 patients had stopped wearing their prostheses. Patients who demonstrated increased walking distances and velocities at follow-up used their prostheses more and their wheelchairs less than did the other patients. Neither gait factors nor hip range of motion at discharge was predictive of continued prosthetic use. Functional outcome and prosthetic use were limited in this group of elderly patients with dysvascular AK and TK amputations. The results of this study may serve as a basis for clinical determination of prosthetic candidacy and functional goals.

Aged↗
PubMed1996

Rodeo thumb: an unusual etiology of avulsion amputation of the thumb.

Though avulsion amputation of the thumb is a devastating hand injury, microsurgical techniques allow for immediate reconstruction and early restoration of function. The majority of these injuries occur in the workplace. An uncommon cause of thumb avulsion amputation is team roping. Recently, several individuals with such injuries presented and underwent successful replantation. Early perioperative venous thrombosis in one case led to secondary reconstruction with a delayed skin flap. Nonetheless, all patients have returned to full activity including team roping.

Adult↗
PubMed1996

Salvage of a below-the-knee amputation with a fillet of foot free flap: a 15-year follow-up.

In the setting of traumatic injury, obtaining suitable coverage to salvage a below-the-knee amputation has been performed by using a variety of tissue flaps, including the fillet of foot free flap. This flap is a free tissue transfer that utilizes the soft tissues of the foot for stump coverage. In this report, we present a 15-year follow-up of a patient with a fillet of foot free flap to demonstrate its applicability and long-term efficacy. We also discuss technical aspects for performing this procedure. In this follow-up, we have found the flap to be extremely durable, even when placed in the weight-bearing position of the stump, and also lacking many of the usual complications associated with the weight-bearing portion (e.g., blisters, ulcerations). We conclude that the fillet of foot free flap is an excellent salvage flap for providing long-term length, coverage, and durability in an amputated, weight-bearing extremity.

Accidents, Traffic↗
PubMed1996

Reorganization of human cortical motor output maps following traumatic forearm amputation.

We report the results of serial transcranial magnetic stimulation mapping of cortical motor outputs to the face and upper extremity in a subject studied before and repeatedly after traumatic amputation of the right arm immediately below the elbow. The results of the mapping studies illustrate the time course of plastic changes in the motor cortical representation in humans following a traumatic amputation and allow the correlation of subjective perceptions of phantom limbs with the reorganization of cortical outputs.

Accidents, Traffic↗
PubMed1998

Acute plasticity in the human somatosensory cortex following amputation.

We studied a patient after amputation of an arm and found that in less than 24 h stimuli applied on the ipsilateral face were referred in a precise, topographically organized, modality-specific manner to distinct points on the phantom. Functional magnetic resonance imaging (fMRI) performed one month later showed that brush-evoked activity in the brain demonstrates objective signal changes which correlate with perceptual changes in the phantom hand. This finding in humans corresponds to the observations of immediate plasticity in cortical pathways described in animals, including primates. The results suggest that reorganization of sensory pathways occurs very soon after amputation in humans, potentially due to the unmasking of ordinarily silent inputs rather than sprouting of new axon terminals.

Adult↗
PubMed1998

Controversies in the treatment of fingertip amputations. Conservative versus surgical reconstruction.

Fingertip amputations are the most common type of amputation injury in the upper extremity. These injuries are either seen in the emergency room or in an office setting. These lesions are very frequent and require precise wound care for optimal results. The longer finger and the thumb, being the most distal and independent mobile parts of the hand are affected very often by these kind of injuries. Treatment of fingertip injuries is a continuous focus of controversy among hand and orthopaedic surgeons. Different treatment options have been described, depending on the affected segment and finger, type of lesion, gender and age of the patient, location, size, and depth of the defect. The indications, advantages, and disadvantages of several reconstructive procedures for fingertip injuries have been described. The techniques themselves are not described in detail.

Amputation, Traumatic↗
PubMed2002

Transtibial amputation with plantar flap for congenital deficiency of the tibia.

Disarticulation of the knee has been the preferred treatment for the severe type (Type Ia and Type Ib classification of Jones et al) of congenital deficiency of the tibia because of marked flexion contracture of the knee and loss of quadriceps function. In such cases, the disarticulated stump is often small and poorly covered by soft tissues because of dysplastic femoral condyles and calf muscles. Therefore, stump complications after disarticulation may prevent early aggressive walking exercises and delay independent ambulation. To overcome this problem, a greater weightbearing surface was created by a transtibial amputation with a short stump of the fibula using the flexed knee. By this method, the distal femoral condyle and the anterior surface of the fibula were used for weightbearing. In addition, coverage of the new weightbearing area by a neurovascular pedicled sensate plantar flap provided a more tolerable weightbearing site. The purpose of the current study was to report a 5-year-old boy with bilateral congenital total deficiency of both tibias, who was treated using this technique. The patient was ambulating independently 15 weeks after surgery. A transtibial amputation with a plantar flap is an alternative procedure to knee disarticulation for the severe type of congenital deficiency of the tibia.

Amputation, Surgical↗
PubMed1994

Reconstructive amputation after grade IIIC open tibial fracture. One method of preserving residual limb length.

A high percentage of patients with grade IIIC open tibial fractures eventually undergo amputation. Maintaining an adequate residual limb length is advantageous with regard to biomechanics, energy expenditure, and prosthetic fitting. This case report presents new considerations for maintaining residual limb length in the presence of comminuted proximal tibial fractures. These considerations include (a) using an autogenous fibular strut graft for stabilizing the reconstructed residual limb and (b) determining the level of amputation based on soft-tissue integrity rather than on fracture level. We present one technique for preserving an adequate residual limb length in the face of significant proximal tibia comminution.

Accidents, Traffic↗