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PubMed1999

Adaptation of dogs to the amputation of a limb and their owners' satisfaction with the procedure.

Forty-four Dutch dog owners were interviewed by telephone about their experiences with their dog after it had had a limb amputated. Most of the dogs adapted to walking on three legs within a month, sooner than most of the owners had expected. There were few complications after the amputation, although changes in behaviour were observed in approximately one-third of the dogs.

Adaptation, Physiological↗
PubMed1979

Lymphography following leg amputation.

Bilateral lower-extremity lymphangiograms were obtained on 2 patients who previously had one leg amputated for unrelated indications. In both cases an underlying malignant tumor was present, and opacification of the lymph nodes draining the amputated limb was clinically important.

Adult↗
PubMed2005

Reducing contralateral SI activity reveals hindlimb receptive fields in the SI forelimb-stump representation of neonatally amputated rats.

In adult rats that sustained forelimb amputation on the day of birth, >30% of multiunit recording sites in the forelimb-stump representation of primary somatosensory cortex (SI) also respond to cutaneous hindlimb stimulation when cortical GABA(A+B) receptors are blocked (GRB). This study examined whether hindlimb receptive fields could also be revealed in forelimb-stump sites by reducing one known source of excitatory input to SI GABAergic neurons, the contralateral SI cortex. Corpus callosum projection neurons connect homotopic SI regions, making excitatory contacts onto pyramidal cells and interneurons. Thus in addition to providing monosynaptic excitation in SI, callosal fibers can produce disynaptic inhibition through excitatory synapses with inhibitory interneurons. Based on the latter of these connections, we hypothesized that inactivating the contralateral (intact) SI forelimb region would "unmask" normally suppressed hindlimb responses by reducing the activity of SI GABAergic neurons. The SI forelimb-stump representation was first mapped under normal conditions and then during GRB to identify stump/hindlimb responsive sites. After GRB had dissipated, the contralateral (intact) SI forelimb region was mapped and reversibly inactivated with injections of 4% lidocaine, and selected forelimb-stump sites were retested. Contralateral SI inactivation revealed hindlimb responses in approximately 60% of sites that were stump/hindlimb responsive during GRB. These findings indicate that activity in the contralateral SI contributes to the suppression of reorganized hindlimb receptive fields in neonatally amputated rats.

Action Potentials↗
PubMed1994

Reorganization of cortical blood flow and transcranial magnetic stimulation maps in human subjects after upper limb amputation.

1. Two complimentary techniques were used to study cortical function in six human upper limb amputees: positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF) were made in subjects during limb movements to study activation of the primary motor (M1), primary somatosensory (S1), and association cortices; and electromyographic responses to transcranial magnetic stimulation (TMS) were measured in proximal upper limb muscles to assess the excitability of corticospinal neurons in subjects at rest. 2. To explore possible cortical mechanisms governing the phantom limb phenomenon, PET and TMS findings were compared between subjects with acquired, traumatic upper limb amputations (n = 3), in whom phantom limb symptoms were prominent, and congenital upper limb amputees (n = 3) without phantom limbs. 3. Paced shoulder movements were associated with significant blood flow increases in the contralateral M1/S1 cortex of both groups of amputees. In traumatic amputees, these increases were present over a wider area and were of significantly greater magnitude in the partially deafferented cortex contralateral to the amputation. In congenital amputees blood flow increases were also present over a wider area in the partially deafferented M1/S1 cortex, but their magnitude was not significantly different from that in the normally afferented M1/S1 cortex. 4. Abnormal blood flow increases also were present in the partially deafferented M1/S1 cortex of traumatic amputees during movement of the ipsilateral, intact arm. Abnormal ipsilateral M1/S1 responses were not present during movement of the intact arm in the congenital group. 5. TMS studies showed that the abnormal blood flow increases in the partially deafferented M1 cortex of traumatic amputees were associated with increased corticospinal excitability.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Is forequarter amputation justified for palliation of intractable cancer symptoms?

BACKGROUND: Limb-sparing surgery has replaced the radical surgical approach for treating limb sarcomas in most cases. Amputation has been advocated as a palliative procedure for symptomatic locally advanced disease that has already failed to respond to radiation therapy, chemotherapy and limited surgery. METHODS: Twelve patients with advanced malignant tumors involving the shoulder girdle or the proximal humerus underwent forequarter amputation (FQA) for palliative purposes. The tumor-related local problems were severe pain, limb dysfunction, tumor fungation, bleeding (requiring emergency FQA in one case) and infection. The preoperative Karnofsky performance status (KPS) in our series ranged from 30 to 70%. RESULTS: No perioperative mortality was observed. The morbidity was well tolerated by the patients. The KPS improved in most of the patients, and was assessed as 90-100% in 9 of the 12 patients. Overall, quality of life was reported to be at least moderately improved by 2 out of 3 patients. Survival was measured in months (3-24 months), but ultimately had no meaning since the procedure was palliative. Lung metastases were the dominant cause of death in our patients. CONCLUSIONS: The results of FQA in our series point to its feasibility and the gain in quality of life and performance status in severely ill patients with advanced malignancies. Local symptoms and signs were controlled, and quality of life was restored.

Adolescent↗
PubMed1980

Phantom and amputation illusions in paraplegic patients.

In paraplegic patients, amputation illusions and anosognosia with phantom position illusions are distinct phenomena which do not concur in any one patient. A permanent amputation illusion regularly follows a complete spinal injury with concomitant brain concussion, whereas all patients who are conscious during their spinal trauma remain aware of their paralyzed limbs in definite phantom positions which are clearly related to the position of the body at the moment of injury.

Adolescent↗
PubMed1987

Baclofen in the treatment of post-amputation autonomous stump movements.

Baclofen at 20-40 mg/day was used to successfully treat two post-amputation patients who developed continuous complex involuntary movements of the proximal extremity. These autonomous movements were otherwise recalcitrant to therapy and were felt to arise from neural generators intrinsic to the spinal cord. Baclofen is known to be useful for spasticity of spinal etiology and now appears to be indicated for treatment of involuntary autonomous movements in post-amputation patients.

Amputation, Surgical↗
PubMed1983

Above-knee amputations in psychiatric inpatients.

Data on 121 primary above-knee amputations and 12 stump revisions performed on a population of nonambulatory elderly psychiatric inpatients showed that the overall morbidity and mortality rates compared favorably with those in previously published reports on other groups of patients who received the same type of amputations, despite the precarious health of the psychiatric patients. By use of spinal anesthesia; meticulous attention to the prevention, early detection, and prompt treatment of wound complications; and identification of patients at high risk, this often desperately needed operation can be performed with good results.

Adult↗
PubMed1987

Acquired amputation and prostheses before the sixteenth century.

Amputation has been practiced at least since 43,000 B.C.E. for ritualistic, punitive, curative, or vocational reasons. Fitting with prostheses has been done since at least 1,500 B.C.E. Anesthetics were used, but which ones is not known. Analgesics such as salicylates in plants, narcotics such as cocaine and opium, and soporifics such as alcohol and peyote were common. Amputation was done with knives, axes, and saws. Control of bleeding was by ligature, cautery, bandaging pressure, and plant and animal products. Suture was with cotton or human hair, acacia and other thorns, ant jaws, and sinew, with or without a drain. Prostheses were made of fiber, wood, bone, and metals, often lined with rags.

Amputation, Surgical↗
PubMed1999

[Questionnaire on the satisfaction of persons with lower-limb amputations towards their prosthesis: development and validation].

The satisfaction of persons with lower-limb amputations towards their prosthesis constitutes a critical factor in the use of the prosthesis. In order to evaluate a person's satisfaction, the SAT-PRO, a self-administrated questionnaire was developed. The questionnaire includes 15 items developed on the basis of the most significant criteria used by the person when selecting a technical aid. These criteria were measured using an ordinal categorical four-level scale. The validation of the SAT-PRO was established from a sample consisting of 61 people with below-knee or above-knee amputations, aging from 60 years and older. The internal consistency of the instrument is high (Cronback's alpha coefficient is 0.90) and the test-retest reliability coefficient (0.97) indicates a very good consistency of the questionnaire over time. Simple and multiple correlations were used to evaluate construct validity. The degree of use of the prosthesis and the feelings of depression, amongst the measured variables, are the best indicators of the satisfaction of the amputees toward their prosthesis.

Aged↗
PubMed2001

Amputations at the London Hospital 1852-1857.

Between 1852 and 1857 at the London Hospital, 142 amputations were performed in 136 patients. The most common indication was an injury sustained at work. Overall mortality was 46% and the death rate was especially high for lower-limb amputations. Most deaths were due to postoperative sepsis. Those who received chloroform anaesthesia did worse than those who received ether.

Amputation, Surgical↗
PubMed2002

Systemic reperfusion injury during arm replantation requiring intraoperative amputation.

This case describes the attempted replantation of an arm following its traumatic amputation. After a five-and-a-half hour ischaemic time, perfusion of the arm was re-established. However over the ensuing hours, the patient developed hyperkalaemia, acidaemia and severe hypotension requiting high dose inotropic support. Ultimately re-amputation was necessary to treat the systemic effects of the ischaemia reperfusion syndrome.

Adult↗
PubMed1983

Emotional aspects of arm or leg amputation in children.

A clinical study of nine children between the ages of 4 and 15, who had undergone arm or leg amputation is presented. The emotional reactions of all those involved - the child, family, and the treatment team - are described. Amputation creates extreme stress in all participants in the procedure. Some similarities were found in the defensive mechanisms and stages experienced by the child, the family and the members of the treatment team.

Adaptation, Psychological↗
PubMed2004

Diabetic neuropathy: review of a surgical approach to restore sensation, relieve pain, and prevent ulceration and amputation.

Diabetic neuropathy occurs in a stocking and glove distribution consistent with a systemic metabolic disease. Historically, this concept led to the conclusion that the only role for surgery in a patient with diabetic neuropathy is for treatment of wounds, amputation, or reconstruction of a Charcot foot. This article reviews the basic scientific and clinical research that support the concepts that metabolic neuropathy renders the peripheral nerve susceptible to compression in patients with diabetes and that decompression of lower extremity peripheral nerves in these patients can relieve pain, restore sensation, and prevent ulceration and amputation.

Amputation, Surgical↗
PubMed1990

Necrosis leading to amputation following clubfoot surgery.

Amputation after clubfoot surgery is a rare and catastrophic complication. This case report involves an amputation necessitated by postoperative necrosis on the medial side of the foot. To our knowledge, only one brief published report of necrosis following clubfoot surgery exists in the literature, and that report contains little clinical information. Although we know of several additional cases of necrosis following clubfoot surgery, the details of these cases remain unavailable to us for publication. The clubfoot deformity is almost always associated with vascular deficiencies involving the anterior tibial and dorsalis pedis arteries, as well as their derivatives. Since the area of necrosis in this case report coincided with the anatomic distribution of the derivatives of the congenitally reduced or absent dorsalis pedis artery, we suggest that insufficient blood flow to the dorsal and medial sides of the foot, and to the hallux contributed to the necrosis. In our opinion, the surgeon should assume that an abnormal vascular pattern, as described here, is present unless proven otherwise.

Amputation, Surgical↗
PubMed2005

Bilateral recurrent discloation of the patella associated with below knee amputation: a case report.

BACKGROUND: Recurrent dislocation of the patella in patients with below knee amputation is a known entity. Abnormally high-riding patella (patella alta) and medial patellofemoral ligament insufficiency in these patients predisposes them to patellar instability. The established treatment of this problem is surgical realignment. CASE PRESENTATION: A 25 year old male patient with bilateral below knee amputation presented with bilateral recurrent dislocation of the patella while walking on knees on uneven ground. Clinical and radiographic studies showed patella alta. A simple shoe modification was used to treat this patient. CONCLUSIONS: A simple shoe modification can be used to treat such a condition which is otherwise treated surgically.

Adult↗
PubMed2002

Limb salvage and amputation in survivors of pediatric lower-extremity bone tumors: what are the long-term implications?

The past four decades have seen tremendous progress in the treatment of pediatric and adolescent cancers. As a consequence, there are increasing numbers of adult childhood cancer survivors. This has prompted investigation into the long-term consequences of cancer treatments. One group that merits special study is the survivors of lower-extremity bone tumors. Their function and quality of life may depend in part on both the surgery and the age at which it was performed. Comparisons between studies are difficult because small numbers of patients and the use of varying research designs and methods have limited research in this area. The purpose of this article is to review the major surgical approaches to lower-limb bone tumors and their impact on pediatric patients. The results show that survival is equivalent between amputation and limb salvage. Complications occur more frequently in limb salvage. The long-term outcomes of those undergoing amputation and limb salvage have not been found to be substantially different in regard to quality of life. In conclusion, prospective long-term follow-up of pediatric patients with lower-limb tumors is needed to (1) determine in a uniform manner the long-term complications, quality of life, and functionality of this population and describe differences within this patient population based on age at diagnosis and surgical procedure, (2) identify areas of concern that are amenable to intervention, and (3) provide clinicians and future patients a better understanding of the surgical options.

Adolescent↗
PubMed2000

Residual function in motor cortex contralateral to amputated hand.

OBJECTIVE: To investigate residual function of the motor cortex corresponding to the hand of the amputated arm (MCamp). METHODS: Focal transcranial magnetic stimulation (TMS) of MCamp was performed in 10 patients 22 to 52 years after arm amputation to inhibit tonic muscle contraction in the intact hand ipsilateral to cortex stimulation. RESULTS: In all patients, onset latency, degree, and duration of this inhibition were normal. CONCLUSION: The presence of motor inhibition in the residual hand of amputees originating from the hand motor representation of MCamp indicates residual cortical motor representation of the lost hand irrespective of whether the effect is mediated by commissural or ipsilateral corticospinal connections.

Adult↗