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At least 1,747 records · Page 97Linked to original sources
PubMed1998

Vascular compromise and amputation after intramedullary nailing of a tibia fracture.

A case is presented of a fifty-three-year-old man with a displaced tibia-fibula fracture that was treated with an intramedullary nail. The morning after surgery pulses were absent and did not improve after fasciotomies. The patient was transferred to our institution, where an arteriogram showed tapering of the anterior tibial and peroneal vessels in the mid-calf and occlusion of the posterior tibial artery at the level of the ankle. Vascular status did not improve after heparinization and arteriogram thrombolysis. The patient ultimately underwent below-the-knee amputation and subsequent revision to above-the-knee amputation.

Amputation, Surgical↗
PubMed1979

Traumatic forequarter amputation: case report.

Traumatic forequarter amputation is rare and extremely mutilating. A 21-year-old male factory worker who sustained a traumatic shoulder girdle amputation is described. The injury mechanism was traction from the machine's force combined with the compressive force on the sternoclavicular joint. The factors leading to survival from this injury include rapid transportation, prompt and effective resuscitation, including treatment of shock, and adequate surgical management. Recognition of the complications associated with retrosternoclavicular dislocation is emphasized.

Accidents, Occupational↗
PubMed1980

The effects of perfusion on an amputated extremity.

The amputated hindquarters of adult female rats were infused with solutions of lactated Ringer's, Collins hypertonic renal perfusate, and dextran-dextrose on a washout and continuous basis. The perfusate was analyzed for energy compounds and breakdown products and the muscle tissue examined histologically. Intermittent perfusion or injection under pressure led to marked edema in a 4-hour period and was abandoned in favor of a system that perfused the part at 120 to 150 cm H2O. The model perfused with Collins gained an average of 1.35 gm, that with lactated Ringer's 2.35 gm, and that with dextran-dextrose lost 2.35 gm. Pressure graphs of the various solutions indicated that the vascular bed reacts more physiologically to Collins solution and dextran-dextrose than to lactated Ringer's. Histologic sections of the muscle biopsies confirmed this. The release of ATP and hypoxanthine with lactated Ringer's suggests that it is the most damaging of the perfusates. These findings support the results of the pressure graphs and histologic studies. A potential for replantation of amputated limbs that contain muscle when the cold ischemia time may exceed 6 hours is suggested by the data presented.

Amputation, Surgical↗
PubMed1988

Chylothorax following traumatic amputation of upper arm.

A young patient who had traumatic amputation of left arm developed extensive chylothorax on right side of chest. The pathophysiology appears to be left subclavian thrombosis secondary to gross sepsis of the amputation stump which resulted in occlusion of thoracic duct opening and chylothorax. The child was successfully treated by closed chest tube drainage.

Amputation, Traumatic↗
PubMedDate not supplied

Amputation of the lower extremity: an overview.

Amputation of the lower extremity may be traumatic or a necessary procedure to prevent further morbidity and possibly death in a patient. Advances have been made in the area of lower extremity amputation surgery and subsequent management. Prosthetic design has resulted in more lightweight, better fitting prostheses that more closely resemble the workings of a normal leg and foot. This results in a decrease in energy expenditure with walking and allows an increased activity level for amputees. This article addresses factors concerning phantom limb sensations and pain, prosthesis use and nursing considerations in rehabilitation.

Amputation, Surgical↗
PubMed1978

Replacement of damaged arteries and veins with vein grafts when replanting crushed, amputated fingers.

Two cases are presented in which multiple vein grafts were used to revascularize several digits in hands injured by severe crushes. One case had partial amputations of 4 digits, and the other had 4 complete amputations. After debriding the damaged parts of the vessels, we interposed vein grafts in both the arterial and venous circulations to the digits. Seven of 8 revascularized digits survived. In crushing injuries, it is essential to debride the vessels proximally and distally to where the intima has not been injured. To bridge the gaps, vein grafts can be used successfully where other methods are undesirable or impossible.

Adolescent↗
PubMed1983

A new technique for reconstruction of an open above-knee amputation.

A case of a short above-knee amputation stump closed with a rectus abdominis musculocutaneous flap is presented. This single-stage procedure provided soft-tissue coverage for the above-knee amputated stump, promoted early ambulation, and preserved bone length.

Amputation, Surgical↗
PubMed1984

Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation.

The purpose of this paper is to document that free-flap surgery may be applied in specific circumstances to elderly patients with extensive vascular insufficiency and wound coverage problems. Below-knee amputation may be a direct but not necessarily desirable answer to the elderly patient with these problems. The problems of increased energy of ambulation, prosthetic fit, and psychological depression are all accentuated in the elderly. Three free-flap patients of an average age of 80 are presented with successful wound coverage, control of ischemic pain, and early return to an independent ambulatory state. The latissimus free flap seems to be an appropriate tool for this purpose. The T-pedicle is especially suited to bridge segmental vascular deficits seen in this population. We conclude that in specific situations, this approach may be an alternative to amputation in the elderly.

Aged↗
PubMed1987

Salvage of amputation stumps by secondary reconstruction utilizing microsurgical free-tissue transfer.

During a 2-year period, 15 lower and upper extremity amputees were treated by microsurgical free-tissue transfer in an effort to salvage their amputation stumps. Salvage of length and restoration of contour to aid in prosthetic rehabilitation were the two main indications for reconstruction. Included in the 15 transfers were 3 scapular free flaps, 11 latissimus dorsi musculocutaneous flaps, and 1 groin flap. Thirteen of the patients in this group were refitted with prostheses following reconstruction and did well with no pain or skin breakdown of the resurfaced stumps. The follow-up period on these patients averaged 16 months. One patient, in whom the flap succeeded, underwent stump soft-tissue revision and myodesis. One patient, in whom the flap failed, continued to develop recurrent ulceration in his stump. This clinical experience followed an extensive laboratory study of 12 above-knee amputation patients using noninvasive Doppler ultrasound measurements to determine weight-loading and interface-pressure distribution between the stump and the socket of the prostheses and their relation to stump length and circumference.

Adolescent↗
PubMed1987

Free flaps to preserve below-knee amputation stumps: long-term evaluation.

Five patients with insufficient soft-tissue coverage on below-knee amputation stumps have been treated with free-tissue transfer surgery to preserve a functional below-knee prosthetic level. The flaps employed include one latissimus dorsi myocutaneous flap, two latissimus dorsi muscle-skin graft flaps, one groin flap, and one foot-fillet flap. All five flaps survived; one patient required early venous anastomosis reexploration and revision. The patients have been followed for a mean duration of 5.5 years (range 3 to 8 years). The mean duration to first ambulation with a prosthesis was 3.6 months (range 2 to 7 months). Four of the five patients developed ulcerations on or adjacent to their flaps which required surgical revision. The patients required a mean of 1.28 prosthesis changes annually since surgery. The functional motion (mean active knee motion is 100 degrees) and ligamentous stability of the knee joints were well preserved in all patients. Five patients wear patella tendon-bearing prostheses, with one requiring an additional thigh corset. In two of the patients, nerve anastomoses to their flaps were performed. Both patients developed true cutaneous sensibility, but nevertheless experienced flap ulceration. All the patients are fully ambulatory on their free flaps. Free-tissue transfer can assist in preserving traumatic below-knee amputations so that patients can benefit from the functional advantage of a below-knee prosthetic device.

Adolescent↗
PubMed1994

Temporary ectopic implantation of an amputated penis.

A case of temporary ectopic implantation of an amputated penis to the forearm followed by subsequent return to its anatomic position is reported. The penis was amputated by a riding lawnmower, and massive contamination of the perineum and an extensive hematoma precluded immediate replantation. The penile vessels were attached to the radial artery and venae comitantes on the forearm, where it survived completely. After 4 weeks, the edema and hematoma of the perineum had resolved, and the penis was returned to its anatomic position by microsurgical technique. Arteries, veins, and nerves were repaired. The penis survived in its entirety. Return of sensation has been excellent. A urethrocutaneous fistula developed that required secondary closure with local flaps. Temporary ectopic replantation of the penis is a useful salvage procedure when the perineum is heavily contaminated or too extensively damaged for immediate replantation.

Adult↗
PubMed2000

Microsurgical replantation of the amputated nose.

A case of successful replantation of the nose is presented. Two arteries and one vein were anastomosed, providing a stable framework for direct revascularization of the amputated nasal segment. This resulted in complete survival of the nose, with an excellent aesthetic result. However, despite successful microsurgical arterial and venous repair, significant postoperative blood loss still occurred as a result of anticoagulation. In cases of the amputation of specialized structures, the improved functional and cosmetic result obtained with replantation must be weighed against the risk of blood-borne disease transmission when postoperative transfusion is required. Recognizing the potential need for postoperative transfusion in these cases is important in allowing the surgeon to exercise appropriate judgment in deciding whether replantation should be performed.

Adolescent↗
PubMed2000

Amputation of the middle ray in the primary treatment of severe injuries of the central hand.

Severe injury to the middle finger often compromises both the appearance and function of the hand. This report discusses the use of total middle ray amputation at the time of primary trauma surgery to avoid predictable problems that arise when the ray, or part of it, is retained. Primary ray amputation eliminates the defective middle finger, avoids a gap hand, and reunites the dissociated radial and ulnar segments of the hand to create a useful, three-fingered hand.

Amputation, Traumatic↗
PubMed2006

Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation.

OBJECTIVE: To examine the clinical significance of changes in chronic pain in 2 disability groups: spinal cord injury and lower limb amputation. METHODS: A reanalysis of 2 controlled clinical trials for pain in persons with disabilities. Eighty-two persons with spinal cord injuries and 34 persons with amputations provided pretreatment and posttreatment ratings of pain intensity on 0 to 10 numerical rating scales. After treatment, participants also rated the meaningfulness of any changes in pain they experienced. RESULTS: An average decrease of 1.80 points on the 0 to 10 numerical rating scales and percent decreases of about 36% corresponded to reports of a meaningful change in pain. There was no significant difference between samples, and also no differences due to gender or treatment condition. Age and pretreatment pain, however, were associated with the amount of pain decrease rated as meaningful. The change in pain intensity rated as meaningful was greater for older participants and participants with higher levels of pretreatment pain. Consistent with previous research, percent change scores were less biased by pretreatment pain than were absolute change scores. DISCUSSION: These findings are generally consistent with similar findings in other pain populations, and, in light of previous research, support an approximate 33% decrease in pain as a reasonable standard for meaningful change across chronic pain conditions. Percent change scores may be more useful for comparing the effects of pain treatments across samples or conditions because they are less biased by pretreatment pain level.

Adult↗
PubMedDate not supplied

Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone.

We wished to determine the relative physical and psychosocial merits of limb-sparing reconstruction, above-knee amputation, and rotationplasty in survivors of childhood and adolescent lower extremity bone sarcoma. In comparing minimum 5-year disease-free survivors, we found that outcome was somewhat dependent on the measuring tool administered. A superior score of statistical significance on the system of evaluation of the Musculoskeletal Tumour Society and a trend toward higher Toronto Extremity Salvage Scores were found among patients with a limb-sparing reconstruction compared with those with an above-knee amputation. Short-Form 36 results and the amount of time spent in the upright position (uptime), as assessed with a remote activity monitor, were similar between these groups. Uptime was highest in patients who had undergone rotationplasty, although statistical assessment of this group was not feasible. Psychosocial outcome was similar between all groups. This information may be useful in discussing reconstruction with patients and their families.

Activities of Daily Living↗
PubMed2005

Combined glenohumeral arthrodesis and above-elbow amputation for the flail limb following a complete posttraumatic brachial plexus injury.

The treatment of a severe traction injury resulting in complete, posttraumatic brachial plexus palsy remains a daunting challenge to the upper extremity surgeon. Operative intervention must address painful glenohumeral instability while optimizing functional rehabilitation. Glenohumeral arthrodesis has been shown to reliably alleviate pain from shoulder instability and place the extremity in a functional position for activities of daily living. An above the elbow amputation has also been advocated to remove the flail insensate extremity and create a stable stump for prosthetic training and rehabilitation. We describe the technique of a combined glenohumeral arthrodesis and above elbow amputation to address the flail insensate limb following a severe posttraumatic brachial plexus injury. In our clinical experience, the combination of procedures results in an improved pain level, enhances shoulder stability, encourages functional rehabilitation via prosthetic fitting, and is associated with high patient satisfaction.

Amputation, Surgical↗
PubMed2006

Surgical treatment of chronic phantom limb sensation and limb pain after lower limb amputation.

BACKGROUND: Therapy for phantom sensation and phantom limb pain following amputation is still difficult, because pathophysiologic mechanisms have not been clarified. This report illustrates a simple and useful surgical intervention. The authors propose that changes at the peripheral nerve site can influence the central feeling of phantom sensation and pain. METHODS: Fifteen patients (mean age, 56 years) with lower limb amputation were included in the study. In all patients, the sciatic nerve was split at a point approximately 3 cm proximal to the popliteal fossa, and the two parts were reconnected in a sling fashion using an epiperineurial technique under microscopic vision. The nerves were covered with a fibrin patch and anesthetics were applied by means of a local pain catheter. Frequency, duration, intensity, and quality of phantom pain were compared preoperatively and 1 week, 3 months, 6 months, and 1 year postoperatively. RESULTS: Fourteen of 15 patients defined the procedure as very helpful. Average, maximum, and minimum pain intensity were significantly reduced 1 week, 3 months, 6 months, and 1 year postoperatively (p < 0.001). Pain intensity scores decreased significantly over the long term after surgical intervention (median visual analogue scale score: preoperatively, 7; 1 year postoperatively, 4) (p < 0.001). The duration of pain attack shortened from approximately 120 minutes to 5 to 10 minutes. CONCLUSIONS: This study shows that accurate treatment of the peripheral nerve can help to successfully reduce phantom limb pain. The authors feel encouraged to perform future investigations to test their operative method in a prospective, randomized, matched control study including electrophysiologic tests for more objective pain assessment.

Adult↗