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At least 19 recordsLinked to original sources
PubMed2002

[Functional outcome and quality of life after ray amputation versus amputation through the proximal phalanx of the index finger].

Little data is available about the long-term functional outcome and quality of life after ray amputation or amputation at the level of the proximal phalanx of the index finger. The purpose of this study was to evaluate the functional outcome and postoperative quality of life after ray amputation or amputation through the proximal phalanx to create a database which is helpful in the decision whether to amputate a digital ray or to preserve a stump.58 patients with amputation of the second ray and 12 patients with amputation through the proximal phalanx of the index finger between 1987 and 1996 were included in the study and examined with respect to hand strength, sensibility, range of motion, pain, and aesthetic result of the hand. Subjective functional outcome was evaluated using the DASH-questionnaire. The majority of patients were male (78 % with ray amputation/83 % with amputation through the proximal phalanx). In 55 %/58 % the operation was performed on the dominant hand. Average age was 45 years and average follow-up was 44.2 months after ray resection and 22.1 months after amputation through the proximal phalanx. Patients lost an average of 10.7 weeks of work after ray amputation and 8.1 weeks after digital amputation. There was no significant loss of grip strength after ray amputation (29 % to 34 % loss of grip strength, 32 % loss of pinch grip) compared with patients after amputation through the proximal phalanx (21 % to 28 % loss of grip strength, 17 % to 35 % loss of pinch grip). DASH-score was 31.3 after ray amputation and 21.7 after digital amputation. Patients with amputation through the proximal phalanx reached a significantly better result in part B of the DASH-questionnaire. 65.5 % of the patients after ray amputation and 91.7 % after digital amputation complained of postoperative pain in the operated hand. Decreased sensibility was found in 55.2 % after ray resection and in 33.3 % after digital amputation. All patients after amputation through the proximal phalanx but only 82.8 % after ray amputation showed a free range of motion of the operated hand. The aesthetic appearance of the operated hand was rated higher after ray amputation. The results show that there is no significant loss of strength after ray amputation compared to amputation through the proximal phalanx as mentioned in the literature. Patients with amputation through the proximal phalanx demonstrate a better functional outcome, while the aesthetic appearance was rated higher after ray amputation. A significant difference was only found in part B of the DASH-questionnaire. This should be considered when the indication for ray amputation is pending.

Adolescent↗
PubMed1998

Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations.

OBJECTIVES: To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides. DESIGN: Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations. SUBJECTS: Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening. METHODS: The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded. RESULTS: Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast, from published general population surveys only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips. There was a significant decrease in femoral neck BMD in the amputated side (p <0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees (p = 0.0027) as compared to normal age- and sex-matched population. CONCLUSION: Male war veterans with unilateral major lower limb amputations develop significantly more osteoarthritis of the hip than expected on both ipsi- and contralateral sides. Amputation was also associated with loss of bone density. Above-knee amputees develop significantly more hip osteoarthritis and osteopenia of greater severity in the amputated side than below-knee amputees.

Aged↗
PubMed1999

Level of amputation following failed arterial reconstruction compared to primary amputation--a meta-analysis.

OBJECTIVES: To determine if the level of amputation after failed vascular reconstruction was comparable to the level of amputation after primary amputation. DESIGN AND METHODS: Medline literature search (1975-1996), meta-analysis. RESULTS: The odds ratio of transtibial to transfemoral (TT/TF) amputations was 927/657 = 1.41 (95% confidence limits: 1.278-1.561) in postrevascularisation amputation (PRVA) and 1590/1162 = 1.37 (95% confidence limits: 1.269-1.477) in primary amputation (PA) (p = 0.65). The pooled data show that the number of conversions from transtibial (TT) to transfemoral (TF) amputations due to amputation stump complications were 85/369 (23%) in PRVA against 93/752 (12.4%) in PA (p < 0.01). CONCLUSIONS: We could not detect any difference in TT/TF ratio between PRVA and PA. However, the risk of conversion i.e. reamputation to a higher level is higher after PRVA compared to PA. The chance of having a successful transtibial amputation is approximately 58% for postrevascularisation amputation as well as for primary amputations. An aggressive approach towards vascular reconstruction seems justified.

Amputation, Surgical↗
PubMed2001

Intermediate rehabilitation outcome in below-knee amputations: descriptive study comparing war-related with other causes of amputation.

AIM: To asses the intermediate rehabilitation outcome of patients with war-related below-knee amputations and compare it with the patients with other causes of amputation. METHOD: The study comprised 74 patients with below-knee stumps admitted for rehabilitation at the Department of Physical Therapy and Rehabilitation, Split University Hospital, Croatia, in 1994. They were fitted with a preliminary prosthesis, a donation from the Finish Red Cross. The rehabilitation was performed by a professional team and included regular bandaging of the stump, exercises to prevent knee and hip joint contracture, general fitness exercises, standing-up, falling and walking exercises, and electrostimulation of the thigh muscles. The time to reach each rehabilitation phase (walking with 2 crutches, walking with 1 crutch, walking with no crutches) was measured. The satisfaction of the patients with the prosthesis was also assessed at the end of rehabilitation. RESULTS: Among 74 patients with below knee amputation, war trauma was the cause for amputation in 31 patients, and in 6 of them the amputations were bilateral. Patients with war-related below-knee amputations were younger than the patients with amputations related to vascular disease, including diabetes. The rehabilitation time was significantly shorter in patients with war-related amputations (61.1+/-11.4 days to walking with no crutches) compared with patients with vascular disease-related amputations (80.9+/-8.1 days; p<0.001). The satisfaction with the prosthesis was more variable in patients with war-related amputations than in other patients. CONCLUSION: Early physical rehabilitation and replacement of the lost extremity with a preliminary prosthesis is an optimal intervention in below-knee amputations due to war-injury. Special attention should be paid to the psychological support to these patients during rehabilitation therapy.

Aged↗
PubMedDate not supplied

Change in major amputation rate in a center dedicated to diabetic foot care during the 1980s: prognostic determinants for major amputation.

From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979-1981 (17 major amputations in 42 inpatients or 40.5%) and 1986-1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46-0.96]. Univariate and multivariate analysis, carried out in the population of the 1990-1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58-37.53), prior stroke (odds ratio 35.05, CI 3.14-390.53), prior major amputation (odds ratio 3.49, CI 1.26-9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01-1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58-12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03-0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.

Amputation, Surgical↗
PubMed2000

Positive meaning in amputation and thoughts about the amputated limb.

The majority of research conducted on the aftermath of amputation understandably concerns itself with its most distressing aspects. This research aimed to explore whether and how people think about their amputated limb, and whether and if they considered anything good had emerged from their amputation. One hundred and four (104) people completed the Trinity Amputation and Prosthesis Experience Scales (TAPES) and two open-ended questions. The majority of participants were young and had traumatic amputations. Fifty-six percent (56%) of people thought about their amputated limb. People with bilateral or a trans-femoral amputation were more likely to think about their amputated limb than people with a trans-tibial amputation. Forty-eight percent (48%) considered that something good had happened as a result of the amputation. Furthermore, finding positive meaning was significantly associated with more favourable physical capabilities and health ratings, lower levels of Athletic Activity Restriction and higher levels of Adjustment to Limitation. Future research and clinical implications are discussed.

Adaptation, Psychological↗
PubMed1988

Results of amputation for gangrene in diabetic and non-diabetic patients. Selection of amputation level using photoelectric measurements of skin-perfusion pressure.

Evaluation was done of 235 patients who had had 273 primary amputations for gangrene. Measurements of local skin-perfusion pressure or systolic blood pressure were made in 222 limbs (188 patients). For the other fifty-one limbs, for which no measurements of pressure were available, the surgeon elected to perform an above-the-knee amputation in nine of seventeen diabetic limbs and a below-the-knee amputation in eight. An above-the-knee amputation was selected by the surgeon for thirty-two of thirty-four non-diabetic limbs and a below-the-knee amputation, for two for which no measurements of pressure were available. Local skin-perfusion pressure was measured distal to the knee before amputation, using a standardized photoelectric technique in 203 limbs and systolic blood-pressure measurements in nineteen. Skin-perfusion pressure was also measured above the knee in seventy-six of the 222 limbs in which a pressure was determined below the knee. These measurements were made available to the surgeon for use as an adjuvant guide to clinical assessment in selecting the appropriate level of amputation. Seventy-four patients (ninety-two amputations) had diabetes and 114 patients (130 amputations) did not. The limbs of the diabetic patients had a significantly higher skin-perfusion pressure at the below-the-knee level (p less than 0.001) than did those of the non-diabetic patients. The ratios of below-the-knee to above-the-knee amputations for the diabetic and non-diabetic patients were 3.8 to one and 1.3 to one (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Major lower extremity amputation in patients with peripheral arterial insufficiency with special reference to the transgenicular amputation.

The selection of the proper level for lower extremity amputation in patients with advanced arterial ischemia poses a multiplicity of problems with regard to operative mortality, stump healing, re-amputation rate and rehabilitation status. In a retrospective study all these parameters have been evaluated in 413 patients submitted to below-knee (bk, n = 196), transgenicular (tg, n = 93) and above-knee (ak, n = 124) amputation between 1971 and 1980. As compared to the ak resection, the bk amputation has the following advantages: lower operative mortality (9% vs. 30.5%), higher prosthetic fitting rate (85% vs. 66%) and significantly improved rehabilitation (walking with artificial limb: bk 84%, ak 22%). Regarding surgical mortality (8.5%) and prosthetic gait (66%), the tg amputation was nearly equivalent to the bk resection and turned out to be clearly superior to the ak amputation. As compared to the latter procedure, knee disarticulation and bk amputation had a greater risk of delayed wound healing and re-amputation at a higher level (ak: 13.5 resp. 1%, tg: 22.5 resp. 25%, bk: 35% resp. 16%). The patient with a bk amputation has the best prospect concerning a successful rehabilitation. Whenever the very important knee joint cannot be saved an ak amputation should be avoided in favour of a knee disarticulation.

Adult↗
PubMed1987

Can the failure of a below-knee amputation be predicted? Predictability of below-knee amputation healing.

The predictability of below-knee amputation healing was evaluated in 69 patients with severe distal ischaemia with or without diabetes mellitus. A special attempt was made to find out predictors of amputation failure. Of 71 amputations performed 20 failed. Preoperative systolic blood pressures and skin perfusion pressures were significantly higher at the level of amputation in patients whose amputations healed than in those whose amputations failed, mean 69.5 (SD 33.4) mmHg and 55.9 (SD 27.0) mmHg vs. 41.5 (SD 31.6) mmHg (p less than 0.01) and 35.6 (SD 13.9) mmHg (p less than 0.05), respectively. There was, however, considerable overlapping and only if calf systolic blood pressure was unmeasurable did below-knee amputations always fail. PVR and skin perfusion pressure data were useful in disclosing falsely high calf systolic blood pressures apparently caused by mediasclerosis. When these patients with pseudohypertension were excluded the presence of diabetes did not affect the pressure readings. The blood viscosity as indicated in this study by pre- and postoperative haemoglobin levels did not affect amputation healing. The present results suggest that vascular laboratory data are useful as supplementary information in the assessment of below-knee amputation healing but it can predict amputation failure only when no Doppler signals are present at the ankle level.

Adult↗
PubMed1999

Delayed amputation in lower limb trauma: an analysis of factors leading to delayed amputation.

An in-depth analysis of the course of events leading to 49 delayed amputation of the lower extremity in 47 patients with open lower limb fractures is presented. Seventeen amputations were performed within one month mainly for vascular reasons. Eleven were between one month and one year, due to persistent sepsis and 21 amputations were performed more than a year after the original injury for infected non-union. Below-knee amputation was done in 32 limbs, above-knee amputation in 13 limbs and Symes' amputation in 4 limbs. The delay in timing of the amputation was analysed with respect to the nature of the injury, the primary treatment and the Mangled Extremity Severity Score (MESS). The MESS score was computed for all injuries and a score of 7 or more predicted an early amputation. We suggest that in all severe lower limb injuries, particularly in Type III C fractures with associated neurological injury, the benefits of an early amputation be considered as an alternative to a limb salvage procedure.

Adolescent↗
PubMed1989

Rehabilitation after lower limb amputation: a comparative study of above-knee, through-knee and Gritti-Stokes amputations.

A study of 169 unilateral amputees under three Disablement Services Centres was performed. The study comprised 88 above-knee, 54 through-knee and 27 Gritti-Stokes amputations. Satisfactory rehabilitation occurred in 33 per cent of above-knee, 62 per cent of through-knee and 44 per cent of Gritti-Stokes patients (56 per cent overall). The better rehabilitation of through-knee versus above-knee amputees (P less than 0.02) was also found in a group of patients matched for comparable age and duration of amputation as well as in a group of age-matched vascular amputees. Through-knee amputees relied significantly less on wheelchairs than above-knee (P = 0.016) and Gritti-Stokes (P = 0.05) amputees. The prosthesis used for the through-knee and Gritti-Stokes amputations was considered unsightly in 50 per cent of cases (versus 31 per cent for the above-knee prosthesis). The superior rehabilitation with through-knee amputations should prompt us to improve both our technique for this amputation and the prostheses currently available. A through-knee amputation should be performed in preference to an above-knee amputation in the case where either is surgically possible, and a below-knee amputation not feasible.

Adult↗
PubMed2001

Lower limb amputations: registration of all lower limb amputations performed at the University Hospital of Trondheim, Norway, 1994-1997.

The authors consecutively recorded all lower limb amputations performed at the University Hospital of Trondheim from January 1st, 1994 to January 1st, 1997. A total of 215 primary lower limb amputations were carried out in the study period: 40 partial foot amputations, 2 ankle disarticulations, 51 trans-tibial amputations, 68 knee disarticulations, 50 transfemoral amputations and 4 hip disarticulations. Seventy-four (74) (34%) of the amputees had diabetes mellitus, 113 (53%) had peripheral vascular disease and 28 (13%) of the amputees had various diagnoses. In those who were amputated due to diabetic and peripheral vascular disease the overall reamputation rate was 19% and 20%, respectively. The rates of reamputation at the trans-tibial and knee level were similar. In the city of Trondheim the annual incidence of primary amputations was 34 per 100,000 and 4.4 per 1,000 diabetic subjects. The incidence of lower limb amputations was 25 times higher in diabetic subjects compared to non-diabetic subjects.

Adolescent↗
PubMed1982

Partial foot amputations in children. A comparison of the several types with the Syme amputation.

We compared the results in fourteen children in whom part of the foot was amputated with the results in a similar group of patients who had a Syme amputation. Based on levels of activity, physical examination, prosthetic requirements, ratio of the length of the fore part of the foot to the hind part, and gait mechanics, we classified the children into three groups. In Group I (patients with a metatarsal ray or transmetatarsal amputation) the results were clearly superior to those in the group with Syme amputation. In Group II (patients with a Lisfranc, mid-tarsal, or Chopart amputation and no equinus contracture) the patients had better over-all function but needed to make greater adjustments for gait than did those with a Syme amputation. In Group III (patients with a Chopart amputation who had an equinus contracture and inadequate length of the fore part of the foot) the results were clearly inferior to those of patients with a Syme amputation.

Adolescent↗
PubMed1995

The modified Pirogoff amputation for traumatic partial foot amputations.

OBJECTIVE: To describe our experience with a modification of the Pirogoff amputation, in the treatment of serious injuries to the hind foot. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: Six patients who required amputation of the hind foot after serious injury. INTERVENTIONS: The modified Pirogoff amputation (amputation of the foot at the ankle with part of the calcaneus left in the lower end of the stump) was done four times as an emergency and twice electively between 1979 and 1991. RESULTS: All the patients were satisfied with their stumps at follow up (7 months-13 years). None had stump pain or phantom pain and they were able to walk about indoors without using the prosthesis. CONCLUSION: We recommend the Pirogoff amputation as the treatment of choice in the management of partial traumatic amputation and other injuries of the foot, should a transmetatarsal amputation be impossible and about 5 cm of the sole of the foot can be preserved.

Adult↗
PubMed2001

Major lower limb amputation following failed infrainguinal vascular bypass surgery: a prospective study on amputation levels and stump complications.

The effect of failed vascular bypass surgery on final amputation level and stump complications is the subject of debate. The aim of this prospective cohort study was to assess the influence of previous infrainguinal bypass surgery on amputees in the authors' centre. Over a three-year period, 234 amputations (219 patients) were performed for critical ischemia. The cause of ischemia was either peripheral obstructive arterial disease (POAD) or diabetes mellitus (DM). Forty-eight percent (48%) (113 amputations) had ipsilateral vascular bypass surgery prior to amputation and 52% (121 amputations) had not. Final amputation level and the post-operative complications of infection, significant stump pain and delayed wound healing were used as the outcome measures for this study. At the end of the study period these outcome measures were used to compare the influence of previous bypass surgery on the two groups of amputees. There was a significantly higher rate of transfemoral amputations (TFA) (32.7%) vs. 16.5%; p < 0.05) and stump infection rate (42% vs. 23%; p < 0.05) in the bypass group. Significant stump pain (p = 0.23) and delayed wound healing (p = 0.24) was more prevalent in the bypass group although statistical significance could not be demonstrated.

Adult↗
PubMed2003

Amputation for acute ischaemia is associated with increased comorbidity and higher amputation level.

BACKGROUND: There is some evidence that the early outcome of major amputation is worse after failed thromboembolectomy, but the risk factors and results of amputation done for acute ischaemia have never been compared with those for chronic ischaemia in a large series of patients. METHOD: Retrospective review of 30 day outcome for all 322 primary amputations done for arterial disease during 1992-8. There were 286 patients (163 male; median age 76 years) who had 270 amputations for chronic ischaemia and 52 for acute ischaemia. RESULTS: The acute group had higher prevalences of cardiac disease (48% versus 29%-p<0.02), limiting pulmonary disease (27% versus 13%-p<0.02) and ASA grades 4 and 5 (27% versus 14%-p<0.05). Amputation below the knee was less common after acute ischaemia (31% versus 60%-p<0.001). There were trends towards more revisions (19% versus 11%) and higher mortality (25% versus 19%) in the acute group but neither reached statistical significance. CONCLUSION: Patients having major amputations for acute ischaemia have higher levels of pre-existing comorbidity than those with chronic ischaemia and are twice as likely to require amputation above the knee. They should be managed as a particularly high risk group.

Acute Disease↗
PubMedDate not supplied

Canine osteosarcoma. Treatment by amputation versus amputation and adjuvant chemotherapy using doxorubicin and cisplatin.

Osteosarcoma was diagnosed in 38 dogs. Thirty-six tumors originated from the appendicular skeleton and two from the axial skeleton. Nineteen of the dogs were treated with amputation alone, and 19 were treated with amputation and adjuvant chemotherapy consisting of doxorubicin and cisplatin. The 36 dogs with appendicular osteosarcoma had complete amputation of the affected limb, whereas the two dogs with osteosarcoma of the axial skeleton had an en bloc resection. The mean survival of the 19 dogs treated with amputation alone was 218 days (median, 175 days). Ten dogs were alive at 6 months and four survived 1 year. None of the dogs survived longer than 16 months. Radiographic lesions consistent with metastatic osteosarcoma were seen after surgery in the nine dogs in which radiographs were taken. The mean survival of the 19 dogs treated with amputation and chemotherapy was 415 days (median, 300 days). Drug toxicity was not observed. Fifteen dogs were alive at 6 months, seven dogs were alive at 1 year, 5 dogs were alive at 2 years, and two dogs were alive at 3 years or longer. One dog is alive and well at 25 months. Radiographic lesions suggestive of metastatic osteosarcoma developed in the other 18 dogs. The 19 dogs treated with amputation and chemotherapy had significantly longer survival times than the dogs treated with amputation alone.

Amputation, Surgical↗
PubMedDate not supplied

Lower limb amputation 2: once the decision to amputate has been made.

This is the second of four articles on lower limb amputation. The first article (Vol 6(17): 970-7) discussed the indications for amputation and briefly outlined the treatment options that may be tried before the amputation stage is reached. This second article examines the factors that need to be addressed once the decision to amputate has been made. It stresses the importance of preparing the patient and his/her family both psychologically and physiologically for the operation. The techniques and rationale for selecting the optimum level of amputation are then discussed. Finally, the specific levels of lower limb amputation are outlined. The next article in this series will explore the nurse's role in preparing the patient for an amputation, and the final article will address the issues raised when a patient decides that death is preferable to living as an amputee.

Amputation, Surgical↗