Journal articles: 'Amputation stump'

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Pohjolainen, T. "A clinical evaluation of stumps in lower limb amputees." Prosthetics and Orthotics International 15, no. 3 (December 1991): 178–84. http://dx.doi.org/10.3109/03093649109164285.

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A study was carried out on 93 consecutive unilateral below-knee (BK) and 62 above-knee (AK) amputees. The dimensions of the amputation stumps were measured and the general condition and contralateral limb assessed at the time of prosthetic fitting. After one postoperative year, follow-up information for 124 (89%) of the surviving patients was obtained by personal contact. The observations were based on the standard formula for stump classification constructed by the International Society for Prosthetics and Orthotics. The 93 BK stumps had a mean length of 16.0 cm and the 62 AK stumps a mean length of 28.0 cm. The scar on the stump was adherent in 13% of BK and 2% of AK stumps. The scar was deeply wrinkled in 7% of BK stumps and 10% of AK stumps. The scar on the stump was most frequently adherent or deeply wrinkled in trauma patients (33%). The skin was undamaged in 93% of all the patients at the first visit and in 94% at the time of follow-up. The mobility of the stump in the proximal joint was limited at the time of prosthetic fitting in 15% of cases. Phantom pain was reported by 59% and stump pain by 5% of patients at this time. Although the phantom pain was mild in most cases, it was usually still present after one year, and 53% of the surviving patients suffered from phantom pain. At the first visit, 20% of patients had problems in their contralateral leg. During the first postoperative year, 6 contralateral BK amputations were performed in the BK group and one contralateral AK amputation in the AK group. Thus, along with examination of the stump, attention must be paid to the contralateral limb with a view to preserving it. The study supports the usefulness of the standard form and classification of amputation stumps.

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Niekerk, L. J. A. van, C. P. U. Stewart, and A. S. Jain. "Major lower limb amputation following failed infrainguinal vascular bypass surgery: A prospective study on amputation levels and stump complications." Prosthetics and Orthotics International 25, no. 1 (April 2001): 29–33. http://dx.doi.org/10.1080/03093640108726565.

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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 trans-femoral 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. Bypass surgery prejudices the amputation level and stump infection rate. Further studies are required to identify the group of patients who would benefit from primary amputation for critical ischemia.

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Francis, W., and C. J. C. Renton. "Mobility after major limb amputation for arterial occlusive disease." Prosthetics and Orthotics International 11, no. 2 (August 1987): 85–89. http://dx.doi.org/10.3109/03093648709078184.

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This study is concerned with the degree of mobility achieved by patients following major amputation for arterial occlusive disease of the legs and its relationship to the level of amputation. Eighty-four out of a possible 85 consecutive amputees form the basis of the study and the degree of mobility was assessed and graded in survivors six months after amputation. Of the 69 survivors 74% were mobile to some degree and 57% walked daily with a prosthesis. Sixty-five per cent of all the amputations were below-knee. Seventeen per cent of below-knee stumps in patients surviving two weeks failed to heal. In amputees who attained a unilateral mobile healed stump 78% with below-knee amputations and 50% with above-knee amputations walked daily with a prosthesis. To obtain maximum mobility the knee should be retained whenever practical even though this results in some unhealed stumps requiring revision.

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Saris, Stephen C., Robert P. Iacono, and Blaine S. Nashold. "Dorsal root entry zone lesions for post-amputation pain." Journal of Neurosurgery 62, no. 1 (January 1985): 72–76. http://dx.doi.org/10.3171/jns.1985.62.1.0072.

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✓ Chronic pain following an amputation may involve the stump, the phantom limb, or both. Operations such as rhizotomy, cordotomy, stump revision, and dorsal column stimulation have been unsuccessful in treating this condition. This study evaluates the effectiveness of dorsal root entry zone (DREZ) coagulation for this pain problem. The authors studied 22 patients with amputations due to trauma, gangrene, or cancer. All developed post-amputation pain, underwent a DREZ procedure, and were followed from 6 months to 4 years after surgery. Overall, only eight (36%) of these 22 patients had pain relief. However, good results were obtained in six (67%) of nine patients with phantom pain alone, and in five (83%) of six patients with traumatic amputations associated with root avulsion. Poor results were obtained in patients with both phantom and stump pain, or stump pain alone. The DREZ procedure has a limited, but definite, place in the treatment of post-amputation pain.

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Wenny, Raphael, Manfred Schmidt, Maximilian Zaussinger, Isabel Zucal, Dominik Duscher, and Georg M. Huemer. "Microvascular free flaps from the lower abdomen for preservation of amputation length in the lower extremity." Clinical Hemorheology and Microcirculation 78, no. 3 (August 3, 2021): 283–90. http://dx.doi.org/10.3233/ch-211112.

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BACKGROUND: The length of the amputation stump is crucial for optimal prosthetic fitting and rehabilitation. Especially in traumatic amputation, direct closure of the stump may be challenging, and bone shortening is frequently needed. To avoid excessive bone shortening, coverage of exposed bone with free flaps is a versatile option. OBJECTIVE: Here we present our experience with the utilization of free flaps from the lower abdomen for the coverage of amputations stumps of the lower extremity. METHODS: Between March 2008 and October 2010, five patients (three female, two male) with complex wounds on amputation stumps of the lower extremity were treated with a mean age of 50 years (range: 15–72 years). Six abdominal free flaps were performed in five patients (one bilateral case), including four deep inferior epigastric artery (DIEP-) and two muscle-sparing transverse rectus abdominis muscle (ms-TRAM-) flaps. Patient’s and operative data were collected retrospectively. RESULTS: One complete flap failure occurred (overall success rate: 83.3%). Three of five patients gained full ambulatory status. CONCLUSIONS: Due to the low donor site morbidity a long vascular pedicle and the large amount of available tissue, abdominal based free flaps represent our first choice for microsurgical reconstruction of lower extremity stumps.

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Loro, A., F. Franceschi, E. C. P. Mosha, and J. Samwel. "A survey of amputations at Dodoma Regional Hospital, Tanzania." Prosthetics and Orthotics International 14, no. 2 (August 1990): 71–74. http://dx.doi.org/10.3109/03093649009080325.

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A survey of 143 amputations performed at Dodoma Regional Hospital, Tanzania between 1983 and 1988 is presented. Consideration is given to indications for amputation, amputation levels, stump revision and supply of prostheses.

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Genov, Pavel G., O. V. Smirnova, and V. H. Timerbaev. "Successful use pulsed radiofrequency spinal ganglions in patient with chronic stump pain. Case report." Regional Anesthesia and Acute Pain Management 10, no. 1 (March 15, 2016): 60–64. http://dx.doi.org/10.18821/1993-6508-2016-10-1-60-64.

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About 50-85% of patients suffer from stump and phantom pain after amputations. These chronic pain conditions are often debilitating and result in disability, sleep and psychosocial disorders, impairment of day-work and the substantial decline in the quality of life. In some patients pharmaceutical therapy may fail to bring satisfactory pain relief or follows severe adverse events. Operations such as rhizotomy, cordotomy and stump revision are often unsuccessful in treating post-amputation chronic pain. The solitary case reports about the using of minimally invasive technique of pulsed radiofrequency (PRF) for treatment of chronic stump and phantom pain have been published only. Our current clinical observation is about successful using of the PRF spinal ganglions in patient with chronic pharmaceutical-resistant post-amputation stump pain.

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Khasanov, Rustamzhon Solievich, Makhmutali Khotamovich Shokirov, Dilmurod Ruzimetovich Ruziboev, Timur Bulatovich Minasov, and Ekaterina Rishatovna Yakupova. "Improvement of prosthetics technology and inpatient rehabilitation of patients with amputation hip stumps." Spravočnik vrača obŝej praktiki (Journal of Family Medicine), no. 5 (May 1, 2021): 14–26. http://dx.doi.org/10.33920/med-10-2105-02.

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Timely and comprehensive assessment of indications and contraindications for prosthetics of patients with a faulty amputation stump has proven to increase the prosthetics efficiency based on adequate approaches to treatment by selecting the correct timing of prosthetics and taking into account the general condition of the patient. Timely elimination of existing defects in the amputation stump with the help of surgical and complex physiotherapeutic procedures, as well as early prosthetics, enables patients with amputation stumps to quickly adapt to the prosthesis. The proposed Prosthetics Efficiency Evaluation Program (PEEP), developed by the authors, allows assessing the degree of prosthetics efficiency and complex rehabilitation of a patient objectively and reliably.

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Baumfeld, Daniel, Tiago Baumfeld, Benjamim Macedo, Roberto Zambelli, Fernando Lopes, and Caio Nery. "FACTORS RELATED TO AMPUTATION LEVEL AND WOUND HEALING IN DIABETIC PATIENTS." Acta Ortopédica Brasileira 26, no. 5 (October 2018): 342–45. http://dx.doi.org/10.1590/1413-785220182605173445.

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ABSTRACT Objective: There are no specific criteria that define the level of amputation in diabetic patients. The objective of this study was to assess the influence of clinical and laboratory parameters in determining the level of amputation and the wound healing time. Methods: One hundred and thirty-nine diabetic patients were retrospectively assessed. They underwent surgical procedures due to infection and/or ischemic necrosis. Type of surgery, antibiotic use, laboratory parameters and length of hospital stay were evaluated in this study. Results: The most common amputation level was transmetatarsal, occurring in 26 patients (28.9%). The wound healing time increased with statistical significance in individuals undergoing debridement, who did not receive preoperative antibiotics and did not undergo vascular intervention. Higher levels of amputation were statistically related to limb ischemia, previous amputation and non-use of preoperative antibiotics. Conclusion: Patients with minor amputations undergo stump revision surgery more often, but the act of always targeting the most distal stump possible decreases energy expenditure while walking, allowing patients to achieve better quality of life. Risk factors for major amputations were ischemia and previous amputations. A protective factor was preoperative antibiotic therapy. Level of Evidence III, Retrospective Study.

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Ali Rafiq Barawi, Omer. "REFASHIONING OF AMPUTATION STUMP." Basrah Journal of Surgery 11, no. 1 (June 28, 2005): 116–23. http://dx.doi.org/10.33762/bsurg.2005.55428.

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Ozyalcin, H., and E. Sesli. "Temporary prosthetic fitting for below-knee amputation." Prosthetics and Orthotics International 13, no. 2 (August 1989): 86–89. http://dx.doi.org/10.3109/03093648909078218.

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The problems encountered in fitting and using the permanent below-knee prosthesis in developing countries are the high price of the prosthesis, inadequate fitting and lack of proper rehabilitation. In Turkey, the preferred treatment of the stump post-operatively is by the soft dressing method with bandaging for maturation and shrinkage. Generally, the application of the permanent prosthesis is in the sixth month post-operatively. Since in patellar-tendon-bearing (PTB) sockets, stumps have to withstand high pressures in limited areas, the PTB socket can only tolerate small volume changes in the stump. For this reason bandaging over a long period may be insufficient for adequate stump shrinkage and amputees will need another below-knee prosthesis, which most of them cannot afford after only a few weeks use. In the authors' clinic, 19 amputees were fitted with simple, effective and inexpensive temporary prostheses following either conventional immediate post-operative dressing or the soft dressing method. The temporary prosthesis is worn for two months. It produces fast stump shrinkage, helps maturation and permits ambulatory discharge even in bilateral amputees. For economical reasons, only eight of nineteen patients were fitted with permanent prostheses, all wearing them successfully without the necessity of further rehabilitation.

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Konduru, Sandeep, and Amar S. Jain. "Trans-Femoral Amputation in Elderly Dysvascular Patients: Reliable Results with a Technique of Myodesis." Prosthetics and Orthotics International 31, no. 1 (March 2007): 45–50. http://dx.doi.org/10.1080/03093640600982305.

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The clinical and functional results of traditional techniques for trans-femoral amputation are often poor. The ISPO consensus conference on amputation surgery in 1990 at Glasgow recommended myodesis as an important integral part of surgical procedure and should be carried out as much as possible. Muscle stabilization provides a stable functional amputation stump. This improves the prosthetic management and walking ability. A technique of myodesis for trans-femoral amputation has been developed in Dundee, especially for elderly dysvascular patients. The functional and clinical results of this technique were studied in 33 patients, who underwent the surgical procedure. Data regarding patient demographics, postoperative morbidity, mortality and functional status were obtained from a prospectively recorded pro forma. Fourteen patients out of 33, who were operated using this technique, were fitted with artificial limbs. Of these, 11 (78.5%) were still using the prosthesis at a mean follow-up of 40 months. There was 100% primary wound healing. Two patients underwent further revision surgery for delayed stump problems. Good clinical and functional results were obtained using this technique. It is particularly suited for the elderly dysvascular patients, whose stumps are shorter and bone quality poor. The low rate of stump problems and consequent revision surgery enables a more comfortable stump for non-prosthetic users.

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Kadam, Dinesh. "Secondary reconstruction of below knee amputation stump with free anterolateral thigh flap." Indian Journal of Plastic Surgery 43, no. 01 (January 2010): 108–10. http://dx.doi.org/10.1055/s-0039-1699417.

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ABSTRACTBelow knee stump preservation reduces ambulatory energy expenditure and improves the quality of life. Reconstruction of soft tissue loss around the stump is a challenging task. Below knee stump reconstruction demands stable skin with sufficient soft tissue to allow weigh bearing. Microsurgical tissue transfer is increasingly being used as a salvage option. Anterolateral thigh flap with additional vastus lateralis muscle provides extra cushioning effect. We report two cases of amputation below knee successfully salvaged. The anterolteral flap with abundant tissue and stable skin offers a reliable option for cover. Two patients with below knee amputation were reconstructed secondarily. After 6 to 20 months of follow -up, stumps showed no signs of pressure effects. Patients are able to bear 50-70 hours of weight per week.

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Chittoria, Ravi. "Role of topical insulin therapy in amputation stump." Clinical Medical Reviews and Reports 2, no. 4 (August 10, 2020): 01–03. http://dx.doi.org/10.31579/2690-8794/028.

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Wound healing is a complex process with overlapping steps of haemostasis, the inflammatory and proliferative phases, remodelling .Any problem with the edge of the wound can be detrimental to healing and may cause delay in wound healing. In this article, we share our experience of using topical insulin therapy for wound bed preparation in non-healing ulcer over the amputation stump.

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Penn-Barwell, JG, CA Fries, ID Sargeant, PM Bennett, and K. Porter. "Aggressive Soft Tissue Infections and Amputation in Military Trauma Patients." Journal of The Royal Naval Medical Service 98, no. 2 (June 2012): 14–20. http://dx.doi.org/10.1136/jrnms-98-14.

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AbstractDue to the nature of IED injuries, during the conflicts in Iraq and Afghanistan The traditional, two-stage amputation for unsalvageable combat lower limb injuries has evolved into a strategy of serial debridement and greater use of plastic surgical techniques in order to preserve residual limb length. This study aimed to characterise the current treatment of lower limb loss with particular focus on the impact of specific wound infections. The UK military trauma registry and clinical notes were reviewed for details of all lower limb amputation identifying: 51 patients with 70 lower limb amputations. The mean number of debridements per stump prior to closure was 4.1 (95% CI 3.5-4.7). A final more proximal amputation level was required in 21 stumps (30%). Recovery of A. hydrophillia from wounds was significantly associated with a requirement for a more proximal amputation level (p=0.0038) and greater number of debridements (p=0.0474) when compared to residual limb wounds without A. hydrophillia.

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Carvalho, Jose Andre, Mauricio Dias Mongon, William Dias Belangero, and Bruno Livani. "A case series featuring extremely short below-knee stumps." Prosthetics and Orthotics International 36, no. 2 (December 14, 2011): 236–38. http://dx.doi.org/10.1177/0309364611430535.

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Background: Lower limb amputations should be evaluated carefully, especially with regard to the possibility of preserving the knee joint to enable a more physiological gait and lower energy consumption. Below-knee amputations were performed immediately below the tibial tuberosity with maintenance of the insertion of the patellar tendon, resulting in very short, but functional stumps. This case study examined whether very short below-knee stumps allow a more functional gait, as compared to more proximal amputations.Case Description and Methods: Between June 2010 and June 2011, four patients had extremely short below-knee amputations, with resection of the head of the fibula at the junction and reinsertion of the collateral ligaments and structures attached to the tibia. This was followed by placement of a prosthesis with a vacuum-assisted suspension socket.Findings and Outcome: At the end of treatment, patients that underwent transtibial amputations with an extremely short stump were considered well adapted to their prosthesis and were satisfied in relation to the acquired gait patterns.Conclusion: The extremely short below-knee amputation, despite having a short lever arm should be considered as another option for lower-limb amputations, although we cannot yet assure that other patient groups undergoing this level of amputation may have the same results of the study.Clinical relevanceThe extremely short below-knee amputation, despite having a short lever arm should be considered as an option for lower limb amputations, as it can provide a prosthetic provision with a good functional outcome.

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Sano, Kazufumi, and Satoru Ozeki. "Does Graft on Flap Method Work on Sequela of Fingertip Amputation?" Journal of Hand Surgery (Asian-Pacific Volume) 21, no. 03 (September 5, 2016): 428–31. http://dx.doi.org/10.1142/s242483551672022x.

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The graft on flap method, a useful option for the restoration of fresh fingertip amputation, was applied to the reconstruction of the short fingertip stumps resulting from the initial amputated stump plasties. As a modification, a nail bed graft from the big toe and a small cubic iliac bone graft were substituted for the lost tissues normally reduced as a composite graft in fresh cases. Upon follow-up ranging from 1 to 8 years, the grafted bone was found to have been resorpted in all cases. For the reconstruction of short fingertip stumps after the initial amputated stump plasties, acceptable results have not yet been achieved using the graft on flap method.

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Ray, M. S., and B. S. Deepak. "Below knee long stump guillotine amputation for mine blast injury foot: a safe need to do primary management in war zone: an experience in 18 cases over 10 months." International Surgery Journal 4, no. 3 (February 25, 2017): 971. http://dx.doi.org/10.18203/2349-2902.isj20170845.

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Background:Somewhere in western sector, high intensity conflict zone, we had to manage a large number of battle causalities, especially gunshot wound abdomen, and mine blast injury foot. In our collective experience of working in battle strife- zone, we realized that the best and the least a surgical team can do is to execute an old fashioned ‘long stump’ below knee (BK) guillotine amputation, achieve perfect hemostasis, immobilize the limb and rapidly transport the patient to higher surgical centre. This increase in the magnitude of mine blast injuries prompted us to highlight the problem and its management.Methods: We analyzed 18 cases of anti- personnel mine blast injury foot over a 10 months period 2000 to 2001. We have managed 18 mine blast feet in “staged- manner. Stage I- “on battle-field” long stump BK guillotine amputation, perfect hemostasis, wound toileting and stump immobilization. Stage II - at a higher surgical centre elsewhere, the patient underwent a planned BK, prosthetic compatible, posterior myo-cutaneous flap covered stump construction and stage III - On recovery the patient with healed BK stump was transferred to limb prosthesis centre where tailor made BK prosthesis was provided and patient rehabilitated.Results:Various body regions were involved in the mine blast injuries, but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 18 patients underwent below knee (BK) amputation while 01patient required bilateral BK amputations. The initial aggressive BK Guillotine amputation saved the limb and life of all patients. Few had stump related self-limiting complications. Some had post-traumatic stress disorder (PTSD). Almost all of them had high degree of BK prosthesis acceptance.Conclusions:Mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. In our experience on 18 cases this “safe-need-to-do” staged management of mine blast injury foot, in high conflict area, was found to be least time consuming, less precious resource draining and hardly manpower straining strategy.

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Dhawan, AmitKumar, Chander Grover, Kavita Bisherwal, VinodKumar Arora, and Reena Tomar. "Verrucous hyperplasia of amputation stump." Indian Journal of Dermatopathology and Diagnostic Dermatology 2, no. 1 (2015): 23. http://dx.doi.org/10.4103/2349-6029.160985.

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Provost, Ninon, Vincent M. Bonaldi, Laurent Sarazin, Kil Ho Cho, and Rethy K. Chhem. "Amputation stump neuroma: Ultrasound features." Journal of Clinical Ultrasound 25, no. 2 (February 1997): 85–89. http://dx.doi.org/10.1002/(sici)1097-0096(199702)25:2<85::aid-jcu7>3.0.co;2-f.

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Sautreuil, P., B. Bignami, D. Mazavet, L. Borini, and P. Thoumie. "Amputation Stump Pain and Acupuncture." Journal of Acupuncture and Meridian Studies 11, no. 4 (August 2018): 216. http://dx.doi.org/10.1016/j.jams.2018.08.106.

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Pfeil, J., E. Marquardt, T. Holtz, F. U. Niethard, E. Schneider, and C. Carstens. "The stump capping procedure to prevent or treat terminal osseous overgrowth." Prosthetics and Orthotics International 15, no. 2 (August 1991): 96–99. http://dx.doi.org/10.3109/03093649109164641.

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Terminal overgrowth in transverse deficiencies and in amputations, particularly of the humerus and tibia necessitate serial trimming procedures or re-amputation. Capping using an autogenous bone graft or a titanium and polyethylene endoprosthetic cap provides a satisfactory way of voiding these re-amputations and allowing end-bearing.

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Delcomyn, F. "Perturbation of the motor system in freely walking cockroaches. II. The timing of motor activity in leg muscles after amputation of a middle leg." Journal of Experimental Biology 156, no. 1 (March 1, 1991): 503–17. http://dx.doi.org/10.1242/jeb.156.1.503.

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1. The effects of amputation of a middle leg on the motor pattern in the legs of freely walking cockroaches (Periplaneta americana L.) were studied. 2. The general effects of amputating a middle leg are similar to those arising from amputation of a rear leg. These effects are: multiple bursting, more variable and inconsistent timing (phase) between bursts and a tendency for timing effects to appear only during relatively slow walking. 3. The phase of bursts in the amputated stump relative to bursts in the leg in front of it was speed-dependent. However, the phase of stump bursts relative to bursts in the legs across from and behind the stump were not especially dependent on the speed of walking. In general, the phases of bursts in most leg pairs seemed relatively little affected by the amputation except for an increase in scatter. 4. It is concluded that loss of a middle leg disrupts the motor pattern less severely than does loss of a rear leg. The implications of this and other results for the understanding of motor control are discussed.

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Baars, E. C. T., P. U. Dijkstra, and J. H. B. Geertzen. "Skin problems of the stump and hand function in lower limb amputees: A historic cohort study." Prosthetics and Orthotics International 32, no. 2 (January 2008): 179–85. http://dx.doi.org/10.1080/03093640802016456.

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The aim of this study was to investigate the relationship between liner-related skin problems of the stump in patients with a lower limb amputation and impaired hand function. Sixty patients who were treated in a rehabilitation hospital from 1998–2006 were included in an historic cohort study. Data were collected concerning the amputation, skin problems of the stump, co-morbidity, hand function, the prosthesis, liner use and mobility score. The study population consisted of 50 trans-tibial and 10 knee disarticulation amputees, 43 male and 17 female, with a mean age of 62.3 years. The majority (63%) had a vascular reason for amputation. Blisters, folliculitis, rash and surface wounds on the stump were operationalized as being liner related. In patients with an impaired hand function, 70% had experienced liner-related skin problems of the stump, whereas 32% of the patients with a normal hand function had experienced skin problems ( p = 0.035). This study shows that impaired hand function poses an increased risk for skin problems in the amputation stump in patients with a lower limb amputation and liner use in their prosthesis.

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Lilja, M., P. Hoffmann, and T. Öberg. "Morphological changes during early trans-tibial prosthetic fitting." Prosthetics and Orthotics International 22, no. 2 (August 1998): 115–22. http://dx.doi.org/10.3109/03093649809164472.

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Morphological changes in the amputation stump may have serious implications regarding the suspension and fit of the prosthetic socket. In an earlier study (Lilja and Öberg, 1997) the authors have shown that the volume of the transtibial amputation stump decreases according to a negative power function after amputation, and that the stump volume does not stabilise until four months after the operation. In the present study, Magnetic Resonance Imaging (MRI) technique was used to examine morphological changes in the amputation stump after transtibial amputation in a small number of cases. The authors expected to find a decrease in the cross-sectional area of the stump and of the separate muscles similar to the findings in earlier studies. However, two different patterns were found. The cross-sectional area of the entire stump as well as that of the medial muscle group changed according to the authors' hypothesis, i.e. an initial fast decrease, followed by a more moderate decrease of the area. In the lateral muscle group another pattern was found. After an initial rapid decrease the area increased, sometimes to a magnitude larger than the initial value. After the amputation the lateral muscle group may acquire a new function, contributing to the suspension of the socket. Despite the limited number of patients, this study presents findings which may be important in the clinical fitting of trans-tibial prostheses.

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Okamoto, Auro Mitsuo, Roberto Guarniero, Rafael Ferreira Coelho, Fabricio Ferreira Coelho, and André Pedrinelli. "The use of bone bridges in transtibial amputations." Revista do Hospital das Clínicas 55, no. 4 (August 2000): 121–28. http://dx.doi.org/10.1590/s0041-87812000000400003.

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We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.

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Visser, C. "Knowledge and skill of patients with regard to amputation stump bandaging, prior to a prosthesis." South African Journal of Physiotherapy 54, no. 3 (August 31, 1998): 8–10. http://dx.doi.org/10.4102/sajp.v54i3.588.

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A swollen or poorly coned stump makes it impossible fo r the prosthetist to provide a patient who had an amputation with a prosthesis.It is both costly, and time consuming for the patient and the amputation team if the patient needs to make repeated visits to the clinic. The purpose of this study is to determine the knowledge and skill of patients with regard to amputation stump bandaging. Thirty-three lower limb amputees, who visited the amputation clinic, were randomly chosen to participate in this survey. The investigation included a questionnaire and a physical evaluation by a physiotherapist on the effectiveness of the bandaging.Results: Only 16 (49%) of subjects received information, education and demonstration on bandaging for their stump. Three of the 16 subjects were judged to have had effective stump bandaging. From this study it is clear that there is a lack of knowledge and skills relating to bandaging amongst amputation patients and that this urgently needs to be rectified to ensure maximal functional outcomes.

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Moon, Daniel, Kenneth Smith, Alexander Shu, Shanthan Challa, and Kenneth Hunt. "Clinical Outcome Differences Between Single and Multi-stage Transtibial Amputations." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0031. http://dx.doi.org/10.1177/2473011419s00310.

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Category: Diabetes, Trauma, Amputation Introduction/Purpose: Transtibial amputations are often necessary when patients experience irreversible tissue damage in their lower extremities. Current amputation methods incorporate either a single-stage amputation with primary wound closure or a two-stage amputation. A two-stage amputation consists of an initial amputation, typically performed at a more distal site, followed by a second more proximal amputation with stump formalization. The reported advantages of two-staged amputations include decreased muscle retraction and the reduced spread of infection/necrosis. This has been reported to allow for reduced failure rates and lower rates of stump revision. Since two-stage amputations are associated with increased monetary costs, time spent in the hospital, and clinical resources used over single-stage amputations, establishing the differences between the clinical outcomes of both types of amputations can provide benefit-cost insight. Methods: This study was a retrospective study, so we began by pulling a query for all patients that underwent a below-the-knee amputation at our institution from January 1, 2015 through January 1, 2018. We excluded revision amputation patients and patients that suffered a traumatic amputation. We will then perform a chart review while recording demographic data, comorbidities, indication for amputation, labs and culture data if present. We will also record the final outcome of the surgery including any revision surgeries. We will collect data on total length of stay and total cost of care from the date of index surgery to the date of prosthetic fitting. For the cost analysis, a Markov model will be used, which can be incorporated with decision tree modeling to estimate the usage of healthcare resources by determining costs through the different phases of healthcare. Results: Our query returned 152 total patients, of which we estimate approximately 25% to 33% underwent a two staged amputation based on the surgeon’s typical amputation preferences. A power analysis was performed which suggested we needed 144 total patients to show a 20% anticipated absolute reduction in complication rates in two-stage amputations compared to single-stage amputations, based on a previous study. We just received the data this week and have not yet performed the full chart review. We hypothesize that two-stage amputations will be considerably more costly than single-stage but that the more involved two-stage strategy may be beneficial in certain subgroups of patients. Conclusion: While we do not yet have the chart review completed for this project, we are excited to elucidate the differences between single-stage and two-stage amputations. We anticipate having all data extracted within the next two months and a complete manuscript by the beginning of the summer. This project has the strong potential to change clinical practice of how trans-tibial amputations are performed depending on the outcome, revision rates, wound complication rates and total healthcare costs.

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Shevchuk, Viktor I., Yurii O. Bezsmertnyi, Halyna V. Bezsmertna, Tetyana V. Dovgalyuk, and Yankai Jiang. "REPARATIVE REGENERATION AT THE END OF BONE FILING AFTER OSTOPLASTIC AMPUTATION." Wiadomości Lekarskie 74, no. 3 (2021): 413–17. http://dx.doi.org/10.36740/wlek202103106.

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The aim: To study the role and place of bone grafting in the formation of bone stump after amputation. Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture. Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling. Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.

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Orhun, H., G. Saka, E. Bilgic, and B. Kavakh. "Case report: Lengthening of short stumps for functional use of prostheses." Prosthetics and Orthotics International 27, no. 2 (August 2003): 153–57. http://dx.doi.org/10.1080/03093640308726672.

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The length of a stump plays an important role when using a prosthesis. It is essential to have an adequate length in the stump in order to apply the prosthesis. Therefore, it is necessary to attempt to lengthen short stumps. The authors have reviewed the results in 2 patients who had such lengthening of stumps one due to traumatic amputation of the forearm at 6.25cm distally from the elbow and the other due to congenital deficiency of the radius and ulna treated by the Ilizarov techinque to improve the fitting of prostheses. Sixty percent (60%) and 40% lengthening was achieved respectively. At the end of the lengthening process, sufficient stump length for the prosthesis was achieved. There were no major complications. As a result, it is believed stump lengthening is a valuable method for cosmetic and functional use of the prosthesis. The Ilizarov Technique is an effective method of lengthening of a stump and it does not require a tissue expander in selected patients. Patients have been able to use their prosthesis 6 months after surgery.

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Hahn, Hyung Min, Kwang Sik Jeong, Myong Chul Park, Dong Ha Park, and Il Jae Lee. "Free-Flap Transfer for Coverage of Transmetatarsal Amputation Stump to Preserve Residual Foot Length." International Journal of Lower Extremity Wounds 16, no. 1 (February 6, 2017): 60–65. http://dx.doi.org/10.1177/1534734616689508.

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Surgical management of soft-tissue defects of the forefoot and midfoot caused by trauma or diabetic complications can be challenging because locoregional tissue is insufficient to provide adequate flap. This deficiency necessitates higher-level amputations, such as Chopart or even transtibial amputation, resulting in far more debilitating functional outcomes than are seen with partial foot amputation. The purpose of this study was to examine the surgical outcomes after transmetatarsal amputation and a free-flap transfer to preserve foot length. This prospective case series was conducted from January 2011 to December 2015 at the Department of Plastic and Reconstructive Surgery at our institute. A total of 16 patients (11 men and 5 women) were enrolled in this study, all of whom were candidates for higher-level amputation because of inadequate soft-tissue coverage after debridement. Each patient underwent transmetatarsal amputation and reconstruction of the amputation stump using free-flap transfers to preserve foot length. Preoperative and postoperative data were collected to evaluate the postoperative outcomes. All 16 free-flap transfers were successful, with no major complications. In 2 cases, partial flap necrosis required additional skin grafting. The mean follow-up period was 24.3 months (range = 7-55 months). Flap coverage was stable, and all the patients were comfortable with their prostheses at long-term follow-up. Use of a free flap to reconstruct a transmetatarsal amputation stump provided stable coverage, preserved maximal foot length, and resulted in good functional outcomes.

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Bloemsma, Gijsbert C., and Oren Lapid. "Marjolinʼs Ulcer in an Amputation Stump." Journal of Burn Care & Research 29, no. 6 (November 2008): 1001–3. http://dx.doi.org/10.1097/bcr.0b013e31818ba0bf.

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Requena, L., F. Vázquez, C. Requena, A. Aguilar, and P. Guerra. "Epoxy dermatitis of an amputation stump." Contact Dermatitis 14, no. 5 (May 1986): 320. http://dx.doi.org/10.1111/j.1600-0536.1986.tb05292.x.

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Ashraff, Suhel, Muhammad A. Siddiqui, Derek Santos, and Thomas Carline. "Prediction of stump healing in lower limb amputation: a narrative review." Journal of Wound Care 28, Sup12 (December 1, 2019): S18—S25. http://dx.doi.org/10.12968/jowc.2019.28.sup12.s18.

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Both types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.

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Shevchuk, Viktor I., Yurii O. Bezsmertnyi, Halyna V. Bezsmertna, Tetyana V. Dovgalyuk, and Yankai Jiang. "BIOMECHANICAL FACTORS IN RESIDUAL LIMB FORMATION AFTER AMPUTATION." Wiadomości Lekarskie 74, no. 7 (2021): 1581–86. http://dx.doi.org/10.36740/wlek202107106.

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The aim: To study the influence of biomechanical factors on the character of morphological disorders in the process of reparative regeneration at the end of the residual limb after amputation. Materials and methods: 10 series of experiments on 144 rabbits were conducted. We used myodesis with normal, insufficient and excessive muscle tension, their electrical stimulation, tight and leaky closure of the bone marrow canal. Terms of observation 1, 3, 6 months. The method of research – histological with the filling of vessels with inkgelatin mixture. Results: Dense closure of the meduallary cavity and uniform muscle tension during plasty in the first three series of experiments allow to obtain a cylindrical residual limb with preservation of the cortical diaphyseal plate, formation of the bone closing plate, normalization of intraosseous microcirculation, completion of the reparative process. In the majority of observations of the IV-X series there was a reparative regeneration disorder connected with the incorrect tension of muscles and the absence of normalization of intraosseous circulation, the reparative process was not observed to be complete, which led to the pathological reorganization of bone tissue with the formation of stumps of various shapes. Conclusions: Uneven muscle tension and lack of closure of the intramedually canal except for microcirculation disorders leads to increased periosteum bone formation, formation of periosteum cartilage exostases, clavate stumps, resorption and fractures of the cortical diaphyseal plate with curvature and stump axis disorders, formation of a conical stump.

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Arazpour, Mokhtar, Mohammad Ali Mardani, Monireh Ahmadi Bani, Fatemeh Zarezadeh, and Stephen William Hutchins. "Design and fabrication of a finger prosthesis based on a new method of suspension." Prosthetics and Orthotics International 37, no. 4 (November 28, 2012): 332–35. http://dx.doi.org/10.1177/0309364612465428.

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Background and aim: Finger amputation is one of the most common types of amputation. Prosthesis with adequate suspension, user-friendly design, and an aesthetic appearance can be effective in the rehabilitation of these patients. The aim of this technical note was to propose a technique for fabrication of finger prosthesis with a new suspension approach for such patients. Technique: To design and accurately fabricate the socket of finger prosthesis, the socket was reduced by 2 mm less than the original value, and a central tunnel with 4 mm width and depth with length matching the distance between the end of the stump and the nail section was provided, so that the silicone material extended to the stump to provide appreciable suspension. Discussion: This study demonstrated the design and fabrication of a silicone finger prosthesis. It also showed silicone finger prosthesis with acceptable suspension, a user-friendly and light design, and a cosmetic appearance constructed for a patient with finger amputation. Clinical relevance Patients with finger amputation usually use prostheses with a simple suspension technique, but evidence suggests that the residuum of these patients experience atrophy and subsequently loss of appropriate suspension. Therefore, this study was required to provide an alternative suspension method in patients with finger amputations.

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Koshkin, B. M. "Experience of using the operation of supravaginal amputation of the body of the uterus without appendages." Kazan medical journal 66, no. 6 (December 15, 1985): 454. http://dx.doi.org/10.17816/kazmj62228.

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A common complication after surgery for supravaginal amputation of the uterine body is prolapse or prolapse of the cervical stump, which necessitates a second operation. As the analysis of the case histories of repeatedly operated patients has shown, some imperfection of the generally accepted classical technique of supravaginal amputation of the uterine body leads to the prolapse of the cervical stump.

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Yurttas, Yüksel, Yüksel Yurttas, Mustafa Kürklü, Bahtiyar Demiralp, and Ali Sabri Atesalp. "A Novel Technique for Transtibial Amputation in Chronic Occlusive Arterial Disease: Modified Burgess Procedure." Prosthetics and Orthotics International 33, no. 1 (January 2009): 25–32. http://dx.doi.org/10.1080/03093640802482559.

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The aim of this study was to compare results of transtibial amputations performed using the Burgess or Modified Burgess techniques with those performed using the Bruckner technique. Transtibial amputation (TTA) was performed in 117 patients with Fontaine phase IV chronic arterial occlusion. Fifty-six patients with a mean age of 51.4 years were amputated by the Burgess technique between March 2000 and January 2003; and 61 patients with a mean age of 47.8 years were amputated by Modified Burgess technique between February 2003 and March 2006. In the Burgess technique, all muscles in the amputation region were preserved and the stump was closed by a long posterior flap; whereas the entire tibialis anterior muscle and part of the soleus muscle distal to the amputation level were removed in the modified Burgess procedure. Stump revision was performed in nine cases (17.3%) amputated by the Burgess technique due to necrosis at the incision site and drainage caused by the peroneal and tibialis anterior muscles; however, two cases (3.6%) of the modified Burgess procedure required stump revision. The prosthesis caused skin maceration at the lateral side of the stump in five cases (9.6%) operated with the Burgess technique and in eight cases (14.5%) operated with the modified Burgess procedure. After the rehabilitation period, 43 patients (82.6%) in the Burgess group were mobilized without crutches in an average of 162.5 days; on the other hand 51 patients (% 92.7) in the modified Burgess group were similarly mobilized in an average of 101.5 days. Our retrospective study showed that the modified Burgess technique, with its advantages and disadvantages forms an alternative to the Burgess and Brückner techniques regarding TTAs.

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Florence, S. L., T. A. Hackett, and F. Strata. "Thalamic and Cortical Contributions to Neural Plasticity After Limb Amputation." Journal of Neurophysiology 83, no. 5 (May 1, 2000): 3154–59. http://dx.doi.org/10.1152/jn.2000.83.5.3154.

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Little is known about the substrates for the large-scale shifts in the cortical representation produced by limb amputation. Subcortical changes likely contribute to the cortical remodeling, yet there is little data regarding the extent and pattern of reorganization in thalamus after such a massive deafferentation. Moreover, the relationship between changes in thalamus and in cortex after injuries of this nature is virtually unexplored. Multiunit microelectrode maps were made in the somatosensory thalamus and cortex of two monkeys that had long-standing, accidental forelimb amputations. In the deprived portion of the ventroposterior nucleus of the thalamus (VP), where stimulation to the hand would normally activate neurons, new receptive fields had emerged. At some recording sites within the deprived zone of VP, neurons responded to stimulation of the remaining stump of the arm and at other sites neurons responded to stimulation of both the stump and the face. This same overall pattern of reorganization was present in the deprived hand representation of cortical area 3b. Thus thalamic changes produced by limb amputation appear to be an important substrate of cortical reorganization. However, a decrease in the frequency of abnormal stump/face fields in area 3b compared with VP and a reduction in the size of the fields suggests that cortical mechanisms of plasticity may refine the information relayed from thalamus.

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Hudson, Justin R., Gerard V. Yu, Roger Marzano, and Andrew L. Vincent. "Syme’s Amputation." Journal of the American Podiatric Medical Association 92, no. 4 (April 1, 2002): 232–46. http://dx.doi.org/10.7547/87507315-92-4-232.

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Amputation at the level of the ankle joint is a valuable but underused procedure for a variety of conditions affecting the foot and ankle. The procedure provides a comfortable and durable stump that allows the lower-extremity amputee to function with minimal disability. This article reviews the indications for Syme’s amputation, provides a detailed surgical description of the procedure, and discusses postoperative prosthetic considerations. In addition, three case reports are presented in which Syme’s procedure was successfully used as an alternative to higher-level amputation. (J Am Podiatr Med Assoc 92(4): 232-246, 2002)

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Nawijn, S. E., H. van der Linde, C. H. Emmelot, and C. J. Hofstad. "Stump management after trans-tibial amputation: A systematic review." Prosthetics and Orthotics International 29, no. 1 (April 2005): 13–26. http://dx.doi.org/10.1080/17461550500066832.

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In order to achieve stump healing after trans-tibial amputation, various methods are applied, such as soft dressings followed by elastic wrapping of the stump, rigid dressings, semi-rigid dressings, and more recently the application of silicon or gel-liners. A systematic literature search was performed to identify the optimal post-amputation management. The methodological quality of the studies was systematically evaluated by using a predefined list of criteria. Only 11 controlled studies were identified and evaluated for their methodological quality. From these studies, no studies were classified as A-level studies, whereas three were classified as B-level, and 8 were classified as C-level studies. Relevant literature appears heterogeneous with respect to patient selection, intervention and outcome measures. Despite the large variability of included studies, this review reveals a trend in favour of rigid and semi-rigid dressings for achieving stump healing and reduction of stump volume. No conclusions can be drawn with regard to the effect on functional outcome. The literature is not conclusive on the effects of early weight bearing on stump healing, volume reduction, and functional outcome. More research is needed for the development of evidence-based clinical practice guidelines concerning management after trans-tibial amputation.

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Takakura, Tomokazu, Taro Mikami, Yasuko Nishioka, Akinobu Nemoto, and Kazuya Mizuochi. "Chronic expanding hematoma in the stumps of persons following transfemoral amputation: A report of two cases." Prosthetics and Orthotics International 38, no. 3 (July 25, 2013): 243–47. http://dx.doi.org/10.1177/0309364613494994.

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Background: Two persons presented with severe stump pain following transfemoral amputation. Case description and methods: A 21-year-old female and a 31-year-old male with transfemoral amputation were ambulatory with prostheses and suffered from severe stump pain caused by the presence of masses around the tip of the bone stump. From the clinical courses, imaging studies, and the intraoperative findings, the masses were diagnosed as a relatively rare condition known as chronic expanding hematoma. Findings and outcome: The two patients were treated successfully with surgical resection. The hematomas were soft cystic masses with a thick capsule containing old blood clots and serous fluid. There were no pathological signs of malignancy. After surgical treatment, the patients achieved walking without stump pain. Conclusion: Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain. Clinical relevance Stump pain is caused by many conditions. Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.

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Wood, M. R., G. A. Hunter, and S. G. Millstein. "The value of stump split skin grafting following amputation for trauma in adult upper and lower limb amputees." Prosthetics and Orthotics International 11, no. 2 (August 1987): 71–74. http://dx.doi.org/10.3109/03093648709078181.

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One hundred and twenty adult patients were reviewed in whom split skin grafts were applied to the stump following traumatic amputation of the upper limb (44 amputees) or lower limb (76 amputees). The average follow-up period was seven and a half years after initial amputation. There was delay in prosthetic fitting in all patients. Approximately one third of patients complained of occasional minor ulceration, controlled by removing the prosthesis for a few days or modification of the prosthesis. Further revision surgery, including excision of the grafted skin often combined with proximal bone resection, but not removal of the proximal joint, was necessary in 29% of below-elbow amputees and approximately 50% of below and above-knee amputees. At the above-elbow level, use of skin grafts allowed prosthetic fitting because of preservation of sufficient length of the stump. Despite the fact that revision surgery may often be necessary, split skin grafting has a definite place in the early management of the stump following traumatic limb amputation in the adult. Preservation of stump length with the knee or elbow joint allows easier rehabilitation and lower energy expenditure when using the prosthesis. Partial foot amputation, when combined with skin grafting usually requires subsequent revision to a more proximal level to obtain a satisfactory result.

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Reiestad, Finn, and Jai Kulkarni. "Role of myofascial trigger points in post-amputation pain: causation and management." Prosthetics and Orthotics International 37, no. 2 (June 20, 2012): 120–23. http://dx.doi.org/10.1177/0309364612447807.

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Background: Post-amputation pain is a multifactorial issue and thus necessitates multiple treatment strategies. Myofascial trigger points-related pain remains under diagnosed and hence not addressed. This study investigates causation and management. Objectives: To identify the presence and role of myofascial trigger points in post amputation pain. Study Design: Post-amputation pain clinic review and recruitment. Methods: Twenty one identified patients in the post-amputation pain clinic with myofascial trigger points were recruited, of which 13 were transtibial and eight transfemoral and all had phantom limb pain and stump pain. The trigger points were identified and injected with long-acting local anaesthetic on a weekly basis and patients were followed up on an ongoing basis. Results: There was significant resolution of pain on the Visual Analogue Scale in the majority of these patients within five weeks, though some of the transtibial cohort needed further eight injections on a weekly basis for resolution of the pain. Conclusion: Identification of myofascial trigger points in amputation stumps and their role in post-amputation pain, followed by appropriate intervention is an important facet of management of this complex chronic pain. Clinical relevance Myofascial trigger points in amputation stumps can lead to ongoing chronic post-amputation pain and our results indicate that identification and intervention of these trigger points does lead to notable resolution of this pain.

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Bensman, V. M., A. G. Baryshev, S. N. Pyatakov, K. G. Triandafilov, V. N. Ponomarev, V. V. Fedyushkin, D. Yu Sheremetyev, A. O. Sheremetyeva, and A. M. Kiba. "Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome." Wounds and wound infections. The prof. B.M. Kostyuchenok journal 8, no. 1 (July 22, 2021): 12–23. http://dx.doi.org/10.25199/2408-9613-2021-8-1-12-23.

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Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.

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Bull, M. J., and M. Saleh. "Amputation stump neuromas: Ultrasound detection and localization." Clinical Radiology 48, no. 5 (November 1993): 339. http://dx.doi.org/10.1016/s0009-9260(05)81304-2.

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Heimke, G�nther. "Biomaterials highlights V. Percutaneous amputation stump extensions." Advanced Materials 2, no. 4 (April 1990): 189–91. http://dx.doi.org/10.1002/adma.19900020408.

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Schwartz, R. A., M. P. Bagley, C. K. Janniger, and W. C. Lambert. "Verrucous Carcinoma of a Leg Amputation Stump." Dermatology 182, no. 3 (1991): 193–95. http://dx.doi.org/10.1159/000247782.

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ELDRIDGE, JOHN C., PETER F. ARMSTRONG, and J. IVAN KRAJBICH. "Amputation Stump Lengthening With the Ilizarov Technique." Clinical Orthopaedics and Related Research &NA;, no. 256 (July 1990): 76???79. http://dx.doi.org/10.1097/00003086-199007000-00012.

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Baptista, Armando, M. A. Barros and, and A. Azenha. "Allergic contact dermatitis on an amputation stump." Contact Dermatitis 26, no. 2 (February 1992): 140–41. http://dx.doi.org/10.1111/j.1600-0536.1992.tb00908.x.

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Journal articles on the topic 'Amputation stump'

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