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Seven cases of above-knee amputation stump breakdown following surgery for arteriosclerosis obliterans were successfully treated with Travase ointment. (Bacillus subtilis proteinase). Rehabilitation was facilitated because secondary closure of the previously infected necrotic wounds could be more rapidly undertaken.
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The causes of pain in the amputation stump or in the so-called phantom limb are far from clear and a wide variety of methods of treatment have been used with varying degrees of success. Surgical techniques do not always give lasting relief and it is suggested that conservative methods such as vibration therapy and various forms of electrical stimulation may prove more helpful.
Thirty-four patients (thirty-seven feet) had a reoperation for pain that persisted after excision of a plantar interdigital (Morton) neuroma. A longitudinal plantar incision was used in thirty-three feet and the previous dorsal web-space incision was used in four feet. Of the thirty-nine pathological specimens that were obtained intraoperatively, twenty-six (67 per cent) contained elements either of primary interdigital neuroma tissue or of an interdigital neuroma in association with an amputation-stump neuroma, indicating that the recurrent pain in these patients had probably resulted from an incomplete initial excision. All but one of the thirty-four patients were available for follow-up at an average of seventy-six months (range, ten to 124 months) postoperatively. Twenty-two patients (67 per cent) had complete relief from or marked improvement in pain, three (9 per cent) had improvement but had persistent pain, and eight (24 per cent) had no improvement or had worse pain. The longitudinal plantar incision was satisfactory in all but one patient and did not result in a painful plantar scar. The number of previously unsuccessful attempts that had been made to excise the neuroma did not adversely affect the results of reoperation in this group of patients.
Evaluation of the functional results and complications of 100 fingertip amputations revealed no difference between the two most commonly used repairs; 52 injuries were treated by primary closure with residual viable skin flaps and 27 by split-thickness skin grafting. No decline in unfavourable functional results was found when patients evaluated 6 weeks after injury were compared to patients evaluated 42 weeks after injury, suggesting that delaying the patient's return to full activity by prolonging rehabilitation is unlikely to yield much improvement. Shortening the nerves in proximal amputations closed by residual flaps did not decrease nerve irritation. Resection of bone produced a mobile amputation-stump tip. While the mean time off work or return to full activity following skin grafting was 6 days less than it was after primary closure, the difference was not significant.
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