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PubMed2003

Reconstruction after total penile amputation and emasculation.

Amputation of the penis and testes is a rare injury in the pediatric population. The authors describe a case of traumatic amputation of the penis and testes presenting late for surgical reconstruction. The surgical reconstruction of this phallus involved advancement of the residual erectile tissue by division of the suspensory ligaments of the penis to lengthen the phallus. A glans penis was fashioned using a full-thickness skin graft with shaft skin provided by a split-thickness skin graft. The use of a tissue expander allowed the creation of a scrotum that accepted two testicular prostheses. Reconstruction of the phallus using these techniques allowed the creation of an erectile, esthetically acceptable phallus. In the situation in which residual erectile tissue remains, this technique can be effectively used in place of musculocutaneous transfer flaps or gender reassignment.

Amputation, Traumatic↗
PubMed2004

Microsurgical revascularization of almost totally amputated alar wing of the nose.

A case of nearly complete amputation of the alar wing is presented whereby a successful arterial revascularization was accomplished using an arterial rerouting technique. Venous stasis was overcome by means of stab-wound wiping. An excellent result was obtained following complete survival of the revascularized segment. The authors conclude that microvascular revascularization should always be attempted whenever possible, even if a skin bridge is preserved in nearly complete amputations of the nose.

Adult↗
PubMed2006

Successful revascularization following near-complete amputation of the tongue.

Successful salvage of the tongue following near or complete traumatic amputation is a rare event. We now report only the second reported successful case of a revascularization of a near or complete amputation of the tongue while in the setting of massive facial trauma. Microscopic revascularization was performed utilizing the left lingual artery and right lingual vein, and despite a prolonged ischemic period, a functional tongue was salvaged. Our patient demonstrated that the tongue can survive up to 16 hours of ischemia. The successful replantation also suggests that arterial blood flow through a single lingual artery and a contralateral single vein may be adequate to perfuse the entire mobile tongue, despite the previously thought avascular median fibrous septum. Tongue revascularization can be performed in the setting of massive facial trauma and large-volume fluid resuscitation.

Accidents, Traffic↗
PubMed2006

Reverse homodigital artery flap coverage for bone and nailbed grafts in fingertip amputations.

The main aim of the treatment of fingertip amputations with no indication of replantation was to establish the functional and esthetic construction. The critical point in the utilization of the bone and nail tissue as a graft for reconstruction was to choose a flap that is sufficiently vascular to nourish these grafts. We have performed homodigital artery flaps to cover the bone and nailbed grafts taken from the amputation to restore fingertip function with an acceptable result. The venous insufficiency with the increased probability in flap failure should be taken into consideration. We proposed the preservation of some amount of soft tissue around the vascular pedicle to overcome the venous insufficiency and in our point of view, digital artery sacrifice was worth it to preserve the length of the finger and the esthetic nail appearance.

Adolescent↗
PubMed2004

Bilateral lower leg replantation versus prosthetic replacement: long-term outcome of amputation after an occupational railroad accident.

BACKGROUND: This retrospective study investigated three very similar cases of bilateral lower leg amputation. The aim was to determine which of two therapeutical procedures is associated with better long-term outcome: replantation or primary treatment of the stumps and subsequent prosthetic replacement. METHODS: Evaluation included clinical examination, gait analysis, and a workup of the psychosocial background. Health problems were documented using the Nottingham Health Profile. Follow-up assessments were performed 6, 7, and 18 years after the trauma. RESULTS: One patient underwent successful bilateral lower leg replantation and continued to work for the same employer. Two patients underwent prosthetic replacement. One became a social outcast confined to a wheelchair. The other patient had a good psychosocial background, similar to that of the patient who underwent replantation. He showed a better gait analysis on even ground than the replantation patient, but the findings were vice versa for uneven ground. CONCLUSIONS: The decision between replantation and prosthetic replacement after bilateral lower leg amputation is case related and cannot be generalized. Patients who have undergone these procedures require long-term psychological and physiotherapeutic care to achieve a good long-term surgical outcome.

Activities of Daily Living↗
PubMed2006

Dysvascular amputations and long-term survival in a 20-year follow-up study.

The long-term survival of 21,520 amputations with a 20-year observation period has been calculated. The material includes 5823 amputees with diabetes and 15 697 dysvascular cases without diabetes. The mean age of the amputees with diabetes is 70.6 years and that of the group without diabetes is 75 years. Kaplan-Meier plots of the absolute mortality in relation to age, gender and level of amputation reveals a significant poor prognosis. Among the diabetic individuals, 30% were dead within 6 months and among the non-diabetic individuals 38.4% were dead during this period. The results from this study with a 20-year follow-up period are compared with the corresponding figures for a 12-year period and no clinically important differences are found.

Aged↗
PubMed1984

Amputations in diabetic patients in Gotland and Umeå counties 1971-1980.

In two counties of Sweden, Gotland and Umeå, lower leg or thigh amputations were performed during 1971-1980 in 111 and 71 diabetic patients, respectively. These figures correspond to 20.5 and 6.5 per 100 000 inhabitants and year, respectively. The corresponding incidence for Umeå city and the rural area surrounding Umeå was 3.1 and 13.8/100 000 inhabitants and year, respectively. The lower frequency of amputations in Umeå was probably the consequence of a restricted period of systematic search for early signs of gangrene, as a part of a research program, but other factors could also be of importance and these are discussed. The death rate of the patients was high in both series, after 2 years only about one third of the patients were still alive.

Adult↗
PubMed2001

Plantar verrucous carcinoma: report of a case treated with Boyd amputation followed by reconstruction with a free forearm flap.

Verrucous carcinoma is a relatively rare, well-differentiated, squamous cell carcinoma. Although it is slow-growing and mimics benign skin lesions, it can cause extensive local destruction that necessitates amputation. It is often underdiagnosed as a benign tumor in its early course. We report a case of extensive verrucous carcinoma on a recalcitrant ulcer and a severe long-standing scar around it on the sole of the right forefoot, which had been treated as a benign tumor for more than two years. We treated it successfully with amputation of the foot and were able to spare the heel by using a free innervated forearm flap to cover the defect at the stump. The present case should remind clinicians that a verrucous lesion developing on a refractory ulcer may be a complex malignant neoplasm; an accurate diagnosis is difficult without a combination of clinical features and pathological findings from an adequately deep specimen.

Amputation, Surgical↗
PubMed1987

Treatment of advanced and inaccessible sarcomas with continuous intra-arterial chemotherapy prior to definitive surgery or radiotherapy--a possible alternative to amputation or disabling radical surgery.

Four patients with advanced and inaccessible soft tissue sarcomas were treated with a regimen of intra-arterial chemotherapy followed by radiotherapy and/or surgical excision. Two of the patients had advanced sarcomas in the buttock and thigh regions which would otherwise have required hindquarter amputation in one case or disarticulation of the hip in the other case. These sarcomas responded significantly to intra-arterial chemotherapy to the extent that subsequent local surgery was effective in eradicating the residual tumours. No viable tumour cells were found in the resected specimens. In both patients amputation was avoided and local tumour eradication was achieved. In the other two patients, advanced and non-resectable sarcomas in the head were first treated with a similar regimen of intra-arterial chemotherapy. In both cases the tumours regressed in size prior to administration of local radiotherapy. After completion of chemotherapy and radiotherapy no viable tumour cells were detected in either lesion. In one case (originally a very extensive sarcoma of the jaw in a 5 year old child) a residual lump was resected but no viable tumour was detected in the resected specimen. These four patients represent our total experience with this plan of management. All responded well and there has been no evidence of local disease recurrence in any of the four patients. One patient (Case 2) did develop pulmonary and bone metastases from which she died 2 years later but the other three patients remain well with no evidence of residual disease, 11 years, 4 years and 20 months after presentation.

Adult↗
PubMed2005

Amputees by choice: body integrity identity disorder and the ethics of amputation.

Should surgeons be permitted to amputate healthy limbs if patients request such operations? We argue that if such patients are experiencing significant distress as a consequence of the rare psychological disorder named Body Integrity Identity Disorder (BIID), such operations might be permissible. We examine rival accounts of the origins of the desire for healthy limb amputations and argue that none are as plausible as the BIID hypothesis. We then turn to the moral arguments against such operations, and argue that on the evidence available, none is compelling. BIID sufferers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests.

Amputation, Surgical↗
PubMed1990

Outcomes of lower extremity amputations.

In an effort to identify variables that could be used to predict outcomes of amputation, a cohort of 97 veteran amputees with a median age of 64 years who underwent 155 lower extremity procedures during 1984 was followed for 15 months. A high incidence of postoperative complication, revision, and mortality with poor quality of life confirm the serious prognosis of these individuals. Regression analyses indicated that peripheral vascular disease and prolonged preoperative hospitalization were associated with complications. Preoperative gangrene and peripheral vascular disease were associated with the need for revision. Complications, a low body mass index, and multiple diseases were related to death. Those with multiple diseases and extensive atherosclerosis were less likely to walk. Ability to perform activities of daily living was the most important predictor of quality of life. Patients at higher risk for these adverse outcomes need to be identified early in their hospital stay. The involvement of the patient or his or her surrogate in decisions regarding the course of treatment and the level of amputation is essential.

Activities of Daily Living↗
PubMed1998

Acute cortisol responses of calves to four methods of dehorning by amputation.

OBJECTIVE: To measure the plasma cortisol response in calves dehorned by four different methods (scoop, guillotine shears, saw, embryotomy wire) for 9 h after dehorning. DESIGN: A physiological study with controls. PROCEDURE: Horn amputation was carried out on calves restrained manually in a race. RESULTS: The four methods of dehorning provoked similarly increased cortisol responses which lasted for 6 h. During the first hour after dehorning the plasma cortisol concentrations were similar to those following ACTH injection. The overall cortisol response to control handling was about 30% of the responses to dehorning. CONCLUSIONS: The similarity of the cortisol responses produced by the four methods of dehorning suggests that the distress experienced by calves following dehorning by amputation is similar regardless of method used.

Amputation, Surgical↗
PubMed2006

Neuropathic pain in a cat post-amputation.

Phantom limb pain is a form of neuropathic pain experienced by human patients who have had amputations. To date there are no reported cases of phantom limb pain in the veterinary literature. A cat presented with signs consistent with neuropathic or phantom limb pain 42 days after iatrogenic sciatic nerve injury and 38 days after subsequent hind limb amputation. Multimodal analgesic therapy resulted in resolution of signs of pain.

Amputation, Surgical↗
PubMed2005

Prevention of limb amputation in patients with limbs ulcers by autologous peripheral blood mononuclear cell implantation.

There are many cases of amputation of ischemic limbs of dialysis patients due to diabetes, despite the availability of medicine therapy and vascular by-pass operations. As there is extensive ruin of the vascular bed due to diabetes, vascular regeneration therapy by stem cell implantation is effective. Thirty patients with ischemic limbs due to diabetes (not including type-I) and on dialysis for chronic renal failure (19 cases), diabetes (5 cases), dialysis patients without diabetes (4 cases), and arteriosclerosis obliterans (ASO, 2 cases) were treated by autologous peripheral blood stem cell (PBSC) implantation where imminent amputation was under consideration. Granulocyte Colony Stimulate Factor (G-CSF: 5 microg/kg/day) was administered subcutaneously for 4 days before PBSC collection, that was carried out using a centrifuge (Spectra and/or CS3000) via the vein. The collected PBSC, containing 4.2 x 10(7) of CD 34 positive cells, was divided into units of 0.5-1.0 mL and implanted, without any purification, to the ischemic area of the limbs in about 65 points. In 21 cases, normalization of limb temperature was observed by thermograph, and symptoms also improved. The result of this first attempt of PBSC implantation is that we were able to save 22 ischemic limbs. This is the first large report of the application of regenerative medicine to peripheral ischemic limbs.

Aged↗
PubMedDate not supplied

Amputation and carboplatin for treatment of dogs with osteosarcoma: 48 cases (1991 to 1993).

Forty-eight dogs with histologically confirmed appendicular osteosarcoma (OSA) entered a prospective clinical trial evaluating treatment with amputation and up to 4 doses of carboplatin given every 21 days. The median disease-free interval (DFI) was 257 days, with 31.2% of the dogs disease-free at 1 year. The median survival time was 321 days, with 35.4% of the dogs alive at 1 year. Dogs with proximal humeral OSA had shorter DFI (P = .016) and survival (P = .037) times than dogs with OSA at other locations. Dogs with lower body weights ( < 40 kg) had longer DFI (P = .0056) and survival (P = .007) times than larger dogs. Survival times for dogs that received carboplatin were statistically longer than those previously reported for amputation alone (P < .001). DFI and survival times are similar to those previously reported for 2 to 4 doses of cisplatin. Carboplatin appears to be a well-tolerated chemotherapeutic drug that can be given safely every 21 days at a dose of 300 mg/m2. Neutropenia was the dose-limiting toxicity in this study.

Amputation, Surgical↗
PubMed2003

[A case of septicemia type Vibrio vulnificus infection with necrotizing fasciitis rescued by lower extremity amputation].

We report a case of septicemia type Vibrio vulnificus infection. The patient was a 74-year-old man who had liver cirrhosis and hepatocelluler carcinoma. He felt a pain in the right femoral lesion after eating raw shellfish (Japanese "Umitake") two days ago. He was admitted to our emergency center due to his shock status and thrombocytopenia two days after the onset. We diagnosed necrotizing fasciitis due to Vibrio vulnificus infection, his life was saved by emergency amputation of the right lower extremity. The culture of the blood and vesicle fluid showed Vibrio vulnificus. There are some reports that the debridement was effective to necrotizing fasciitis due to Vibrio vulnificus infection, but these reports are all about single upper extremity lesion. As far as we know, this is the second report of lower extremity necrotiaong fasciitis due to septicemia type Vibrio vulnificus infection rescued by extremity amputation in Japan. The mortality of septicemia type Vibrio vulnificus infection with necrotizing fasciitis is very high, this is quite a valuable report in making a decision for therapy of septicemia type Vibrio vulnificus infection.

Aged↗
PubMed1994

Vasculitis in patients with systemic sclerosis and severe digital ischaemia requiring amputation.

OBJECTIVES: To document the incidence of histological vasculitis in amputation specimens from patients with severe digital ischaemia secondary to systemic sclerosis (SSc), and to look for an association between anticardiolipin (aCL) antibodies and severe digital ischaemia in SSc. METHODS: This was a retrospective review of patients with SSc who underwent amputation for digital ischaemia over a three year period. RESULTS: Five of nine patients had histological vasculitis, four of whom had aCL antibodies, although these were not present in high titre. CONCLUSION: Vasculitis does occur in SSc, at least in that subgroup with severe peripheral ischaemia. These findings could have implications for treatment of this subgroup of patients with SSc.

Adult↗
PubMed1971

Bone sarcoma: treatment by irradiation, amputation, or a combination of the two.

A retrospective survey of all cases of osteosarcoma of the femur and tibia treated at the major centres in the United Kingdom during 1952-9 was carried out in an attempt to assess the respective value of treatment by surgery and radiotherapy and the feasibility of a larger prospective study. Of the 192 patients available for the comparison, those treated by radiotherapy alone did least well. A combination of the two treatments-radiotherapy followed by amputation-produced better results, in terms of survival, than amputation alone; however, the comparatively small numbers involved and the inadequacy of information about the factors dictating the choice of treatment make firm conclusions impossible. A controlled clinical trial on a larger scale might provide answers to the outstanding questions.

Adolescent↗