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Stoy, Conrad, Stephanie Kwan, Justin Kistler, and Jacob Tulipan. "A Look at the Course and Management of Non-Traumatic Upper Extremity Amputation." Hand and Microsurgery 11, no. 2 (2022): 1. http://dx.doi.org/10.5455/handmicrosurg.23893.
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Objectives Amputation is a major source of morbidity and mortality. Non-traumatic amputations of the upper extremity are less common, and less well-characterized, than the lower extremity. We hypothesize that upper extremity amputations are often associated with multiple returns to the operating room. Methods Twenty-five patients were identified that underwent primary or revision ray or phalangeal amputations for vascular/infectious indications. Chart review was utilized to gather information on additional amputations and demographic information. These groups were compared via chi-squared analysis assuming equal distributions of operations would be present between groups. Results Of the patients with infectious and/or vascular amputations, 56% had a subsequent amputation. Additionally, 23 irrigation and debridement\’s (I and D) were performed before resorting to amputation with 6 patients requiring multiple I and Ds. Post-amputation, 3 patients required I and D, 7 revision amputations at higher levels, 8 amputations of additional ipsilateral digits, and 4 amputations of contralateral digits were performed. After initial amputation, there is a 76% chance of undergoing an additional operation and/or amputation of the upper extremity. A subgroup of these patients with diabetes showed statistically significant increases in ipsilateral amputations following initial amputation. Conclusions Our study shows that patients undergoing digit amputation for nontraumatic indications may require additional upper extremity operations following initial amputation. Subsequent revision amputation at a higher level is common and suggests that more aggressive early amputation may be warranted in these patients. Specifically, diabetic patients are at significantly increased risk of requiring additional digit amputations and may benefit from more aggressive initial surgery at time of presentation.
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Dillon, Michael P., Friedbert Kohler, and Victoria Peeva. "Incidence of lower limb amputation in Australian hospitals from 2000 to 2010." Prosthetics and Orthotics International 38, no. 2 (June 24, 2013): 122–32. http://dx.doi.org/10.1177/0309364613490441.
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Background: Contemporary literature reports that the incidence of lower limb amputation has declined in many countries. This impression may be misleading given that many publications only describe the incidence of lower limb amputations above the ankle and fail to include lower limb amputations below the ankle. Objectives: To describe trends in the incidence of different levels of lower limb amputation in Australian hospitals over a 10-year period. Study design: Descriptive. Method: Data describing the age-standardised incidence of lower limb amputation were calculated from the Australian National Hospital Morbidity database and analysed for trends over a 10-year period. Results: The age-standardised incidence of lower limb amputation remained unchanged over time ( p = 0.786). A significant increase in the incidence of partial foot amputations ( p = 0.001) and a decline in the incidence of transfemoral ( p = 0.00) and transtibial amputations ( p = 0.00) were observed. There are now three lower limb amputations below the ankle for every lower limb amputation above the ankle. Conclusion: While the age-standardised incidence of all lower limb amputation has not changed, a shift in the proportion of lower limb amputations above the ankle and lower limb amputations below the ankle may be the result of improved management of precursor disease that makes partial foot amputation a more commonly utilised alternative to lower limb amputations above the ankle. Clinical relevance This article highlights that although the incidence of lower limb amputation has remained steady, the proportion of amputations above the ankle and below the ankle has changed dramatically over the last decade. This has implications for how we judge the success of efforts to reduce the incidence of lower limb amputation and the services required to meet the increasing proportion of persons with amputation below the ankle.
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Armstrong, DG, LA Lavery, LB Harkless, and WH Van Houtum. "Amputation and reamputation of the diabetic foot." Journal of the American Podiatric Medical Association 87, no. 6 (June 1, 1997): 255–59. http://dx.doi.org/10.7547/87507315-87-6-255.
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The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations.
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Walter, Nike, Volker Alt, and Markus Rupp. "Lower Limb Amputation Rates in Germany." Medicina 58, no. 1 (January 10, 2022): 101. http://dx.doi.org/10.3390/medicina58010101.
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Background and Objectives: The current epidemiology of lower limb amputations is unknown. Therefore, the purpose of this study was to determine (1) lower extremity amputation rates as a function of age, gender, and amputation level between 2015 and 2019, (2) main diagnoses indicating amputation, (3) revision rates after lower extremity amputation. Materials and Methods: Lower extremity amputation rates were quantified based on annual Operation and Procedure Classification System (OPS) and International Classifications of Disease (ICD)-10 codes from all German medical institutions between 2015 through 2019, provided by the Federal Statistical Office of Germany (Destatis). Results: In 2019, 62,016 performed amputations were registered in Germany. Out of these 16,452 procedures (26.5%) were major amputations and 45,564 patients (73.5%) underwent minor amputations. Compared to 2015, the incidence of major amputations decreased by 7.3% to 24.2/100,000 inhabitants, whereas the incidence of minor amputation increased by 11.8% to 67.1/100,000 inhabitants. Highest incidence was found for male patients aged 80–89 years. Patients were mainly diagnosed with peripheral arterial disease (50.7% for major and 35.7% for minor amputations) and diabetes mellitus (18.5% for major and 44.2% for minor amputations). Conclusions: Lower limb amputations remain a serious problem. Further efforts in terms of multidisciplinary team approaches and patient optimization strategies are required to reduce lower limb amputation rates.
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Eidmann, Annette, Yama Kamawal, Martin Luedemann, Peter Raab, Maximilian Rudert, and Ioannis Stratos. "Demographics and Etiology for Lower Extremity Amputations—Experiences of an University Orthopaedic Center in Germany." Medicina 59, no. 2 (January 19, 2023): 200. http://dx.doi.org/10.3390/medicina59020200.
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Background and Objectives: Currently, the worldwide incidence of major amputations in the general population is decreasing whereas the incidence of minor amputations is increasing. The purpose of our study was to analyze whether this trend is reflected among orthopaedic patients treated with lower extremity amputation in our orthopaedic university institution. Materials and Methods: We conducted a single-center retrospective study and included patients referred to our orthopaedic department for lower extremity amputation (LEA) between January 2007 and December 2019. Acquired data were the year of amputation, age, sex, level of amputation and cause of amputation. T test and Chi² test were performed to compare age and amputation rates between males and females; significance was defined as p < 0.05. Linear regression and multivariate logistic regression models were used to test time trends and to calculate probabilities for LEA. Results: A total of 114 amputations of the lower extremity were performed, of which 60.5% were major amputations. The number of major amputations increased over time with a rate of 0.6 amputation/year. Men were significantly more often affected by LEA than women. Age of LEA for men was significantly below the age of LEA for women (men: 54.8 ± 2.8 years, women: 64.9 ± 3.2 years, p = 0.021). Main causes leading to LEA were tumors (28.9%) and implant-associated complications (25.4%). Implant-associated complications and age raised the probability for major amputation, whereas malformation, angiopathies and infections were more likely to cause a minor amputation. Conclusions: Among patients in our orthopaedic institution, etiology of amputations of the lower extremity is multifactorial and differs from other surgical specialties. The number of major amputations has increased continuously over the past years. Age and sex, as well as diagnosis, influence the type and level of amputation.
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Jain, Amit Kumar C., Vishakha M, and Pratheek K.C. "Analysing Diabetic Foot Amputations through Amit Jain’s Extended SCC Classification." Journal of Evidence Based Medicine and Healthcare 8, no. 8 (February 22, 2021): 435–39. http://dx.doi.org/10.18410/jebmh/2021/85.
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BACKGROUND Foot amputations are common in diabetic patients and they are either minor or major. We conducted this study to analyse minor amputations done in diabetic patients through this new Amit Jain’s extended “SCC” classification for foot amputations. METHODS A descriptive retrospective study was conducted in Department of Surgery of Raja Rajeswari Medical College, Bengaluru, Karnataka, India, which is a tertiary care teaching hospital. The study period was from January 2018 to December 2019. This study was approved by institutional ethics committee. RESULTS 32 patients were included in this study with majority of patients being above 40 years. 78.1 % of them were males. Infected ulcers in the foot accounted for 34.4 % of the cases and were the commonest cause for amputation. 96.9 % of the patients who underwent minor amputation were of type 1-foot amputation. 6.3 % ended up in major amputation in the same hospitalisation. There was no in-patient mortality in this study. CONCLUSIONS Diabetic foot amputations are common in clinical practice and they often cause increased morbidity and add financial burden to patients and their family. Toe amputations, which are type 1-foot amputations, are the commonest amputations performed. Type 3-foot amputations are rarely done as they are complicated and require expertise. Amit Jain’s extended SCC classification for foot amputation is a simple, easy to understand and practical classification that categorises the minor amputation into 3 simple types. This is the first such classification exclusive for foot amputation. KEYWORDS Diabetes, Amputation, Foot, Amit Jain, Osteomyelitis, Gangrene, Ulcer
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Leite, Jose O., Leandro O. Costa, Walter M. Fonseca, Debora U. Souza, Barbara C. Goncalves, Gabriela B. Gomes, Lucas A. Cruz, et al. "General outcomes and risk factors for minor and major amputations in Brazil." Vascular 26, no. 3 (October 17, 2017): 291–300. http://dx.doi.org/10.1177/1708538117736677.
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Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.
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Elsherif, Mohamed, Wael Tawfick, Patrick Canning, Niamh Hynes, and Sherif Sultan. "Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene." Vascular 26, no. 2 (October 11, 2017): 142–50. http://dx.doi.org/10.1177/1708538117718108.
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Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetatarsal amputation group ( P = 0.974). 29.9% of digital amputations and 15.7% of transmetatarsal amputations in diabetic patients, required minor amputations or revision procedures ( P = 0.04). Median length of hospital stay was (20 days, IQR 27) in the digital group and (17 days, IQR17) in the transmetatarsal amputation group ( P = 0.17). Need for re-admission was 48.1% in digital patients compared to 50% in transmetatarsal amputation patients ( P = 0.81). Quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) was (315 days, IQR 45) in digital group and (346 days, IQR 48) in the transmetatarsal amputation patients ( P = 0.099). Conclusion Despite the lack of statistical significance, transmetatarsal amputation offered better outcome in the diabetic patients, with less re-intervention rate, shorter hospital stays, less theatre trips, and longer time without toxicity (TWiST).
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Kim, Y. C., C. I. Park, D. Y. Kim, T. S. Kim, and J. C. Shin. "Statistical analysis of amputations and trends in Korea." Prosthetics and Orthotics International 20, no. 2 (August 1996): 88–95. http://dx.doi.org/10.3109/03093649609164424.
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Epidemiological research on amputees is being continued extensively world wide, but there are different epidemiologic reports from country to country. This study undertakes an epidemiologic report of the medical records of amputees in Korea which has developed very rapidly, when compared with other countries. This study included 4258 amputees who either had an amputation and/or received prosthetic training at Yonsei University College of Medicine, Severance Hospital from January 1970 to June 1994. The most common cause of amputation was trauma (66.7%), and the second most common cause was peripheral vascular disease. While amputations due to infection or trauma were the most common in the 1950's, amputations due to peripheral vascular disease have gradually increased until they now make up 23.5% of all amputations in the 1990's. Lower limb amputation, more common than upper limb amputation, accounted for 68.7% of all amputations. Multiple amputation accounted for 9.3% of all amputations, and the occurrence rate of multiple amputation was relatively higher in cases of burn injuries, train accidents, frostbite, and Buerger's disease than in cases brought about by other causes. The various amputation causes change according to the circumstances of the times, as can be seen in this study.
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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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Choe, Deborah, Andrew Humbert, Erin Wolfe, Sarah A. Stoycos, Samuel P. Mandell, Barclay T. Stewart, Gretchen J. Carrougher, et al. "565 Pediatric Patients with Post-Burn Amputations Report Worse Long-Term Physical Function but Not Self Appearance." Journal of Burn Care & Research 45, Supplement_1 (April 17, 2024): 157. http://dx.doi.org/10.1093/jbcr/irae036.199.
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Abstract Introduction Amputation after burn injury may improve survival rates; however, the physical changes and functional impairments resulting from amputation can have long-term consequences. A prior Burn Model System (BMS) national database study found that post-burn amputation among adults was negatively correlated with mental health scores but positively correlated with physical function scores at 6-months post-burn. However, no study has examined long-term outcomes associated with post-burn amputation in the pediatric population. This study investigates longitudinal functional and psychosocial outcomes among pediatric burn patients with amputations. Methods Pediatric participants (8 – 17 years old) enrolled in the BMS database between 2015 – 2023 with post-burn amputations were included. Participants with amputations were matched using nearest-neighbor matching to those without, based on burn location, age and % total burn surface area. Primary outcomes were the PROMIS-25 v2.0 Physical Function and the Child Burn Outcomes Questionnaire: appearance sub-score, measured at 6-, 12- and 24-months post-burn. In addition to cross-sectional pairwise analyses at each time-point, linear mixed effects models were used to assess differences in outcomes between those with and those without amputations after adjusting for time while accounting for repeated measures. Additional linear mixed effects models, including an interaction between amputation status and time, were conducted to assess whether the change in outcome scores across time differed between those with and without amputations. A two-sided significance level of 0.05 was used to determine statistical significance. Results In this study, 17 participants had amputations and 17 did not. A total of 7 participants had upper amputation only, 1 had lower amputation only, 2 had upper and lower amputation and 7 were unknown. Amputation was significantly associated with lower physical function scores (9.3 points lower, p=0.006) after adjusting for follow-up time-points. However, there was no evidence that the difference in physical function scores worsened or improved over time. Pairwise analyses at each time-point found those with amputations reported significantly lower physical function scores at 24-months post-burn (54.9 ±11.6 vs. 66 ±5, p=0.013). No significant differences were found in appearance scores or in the change in appearance scores. Conclusions Amputation was significantly associated with worse physical function scores. Participants with amputation fared as well in appearance scores as those without amputation. Pediatric burn patients with amputations might benefit from tailored amputee-specific rehabilitation services, amputee peer support, and school reentry programs. Applicability of Research to Practice This study can be used to guide recommendations for physical/occupational therapy and other rehabilitative services available to pediatric burn patients with amputations.
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Pohjolainen, T., and H. Alaranta. "Lower limb amputations in Southern Finland 1984-1985." Prosthetics and Orthotics International 12, no. 1 (April 1988): 9–18. http://dx.doi.org/10.3109/03093648809079386.
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To assess the current epidemiological situation concerning lower limb amputations in southern Finland the data on all amputations made in the catchment area of the Helsinki University Central Hospital were analysed for the period 1984-85. During the two-year period, 880 amputations of lower limbs were performed on 705 patients. The amputation rate was 32.5 per 100,000 inhabitants in 1984 and 28.1 in 1985. Patients requiring amputation were arteriosclerotics in 43.1 per cent, and diabetics in 40.7 per cent. Diabetics underwent amputation 3 years younger on average than the arteriosclerotics. The most common site of unilateral amputations was above-knee (42.0 per cent) followed by below-knee (27.7 per cent) and toe amputations (22.2 per cent). The level of amputation tended to become more proximal with increasing age of the patients. The overall mortality figure during three postoperative months was 27.0 per cent. Amputation incidence increased sharply with increasing age. On the base of predictions, the overall age structure of the Finnish population will shift upward causing an increase in the proportion of elderly age groups. A 50% increase in amputation rate is expected in Finland within the next 20-30 years.
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UR-REHMAN, KHALIL, and ATIF UR-REHMAN. "DIABETIC PATIENT." Professional Medical Journal 14, no. 02 (September 6, 2007): 248–54. http://dx.doi.org/10.29309/tpmj/2007.14.02.4884.
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Introduction: Limb loss is most feared complication of diabetes. The statistics associated withamputation create a very real concern. Fifty percent of all non-traumatic amputations occur in the diabetic patient. Therisk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year, six of every thousand diabeticindividuals undergo surgery for an amputation. Objectives: To evaluate the frequency of lower limb amputations indiabetic patients, hence emphasizing the importance of timely surgical intervention in salvage of lower limb and toreduce the morbidity and mortality. Study design Descriptive study. Setting: Surgical OPD, Causality Ward andMedical Unit, Nishtar Hospital Multan. Duration: One year. Material and methods: 100 patients. Results: Theincidence of amputations rose steeply with age; most amputation occurred in patients over 60 year. The incidence wasa higher in men than in women. The incidences of major amputations were 32% than that of minor amputations. Nearly40% of all subjects under going afoot level amputation had a previous history of foot amputation. However nearly 40%of all subjects under going a foot level amputation had not been diagnosed either before or during admission withperipheral arterial occlusive disease, suggesting a casual pathway dependent primarily on neuropathy. The main outcome variables were the number of repeat operations and hospitalization for salvage of limb with recurrent or persistentinfection, and time to complete forefoot healing or foot amputation Conclusions: Amputations performed at healthyzones reduce the hospital stay of the patient but mortality was more consistently for proximal amputations. Betterscreening of diabetic patients with appropriate risk directed treatment at primary care level might significantly impactthe large number of preventable diabetes related lower extremity amputations.
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Trier Heiberg Brix, Anna, Katrine Hass Rubin, Tine Nymark, Hagen Schmal, and Martin Lindberg-Larsen. "Major lower extremity amputations – risk of re-amputation, time to re-amputation, and risk factors: a nationwide cohort study from Denmark." Acta Orthopaedica 95 (February 2, 2024): 86–91. http://dx.doi.org/10.2340/17453674.2024.39963.
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Background and purpose: Re-amputation after lower extremity amputation is frequent. The primary aim of our study was to investigate cumulative re-amputation risk after transtibial amputation (TTA), knee disarticulation (KD), and transfemoral amputation (TFA) and secondarily to investigate time to re-amputation, and risk factors.Methods: This observational cohort study was based on data from the Danish Nationwide Health registers. The population included first-time major lower extremity amputations (MLEA) performed in patients ≥ 50 years between 2010 and 2021. Both left and right sided MLEA from the same patient were included as index procedures.Results: 11,743 index MLEAs on 10,052 patients were included. The overall cumulative risks for re-amputation were 29% (95% confidence interval [CI] 27–30), 30% (CI 26–35), and 11% (CI 10–12) for TTA, KD, and TFA, respectively. 58% of re-amputations were performed within 30 days after index MLEA. Risk factors for re-amputation within 30 days were dyslipidemia (hazard ratio [HR] 1.2, CI 1.0–1.3), renal insufficiency (HR 1.2, CI 1.1–1.4), and prior vascular surgery (HR 1.3, CI 1.2–1.5).Conclusion: The risk of re-amputation was more than twice as high after TTA (29%) and KD (30%) compared with TFA (11%). Most re-amputations were conducted within 30 days of the index MLEA. Dyslipidemia, renal insufficiency, and prior vascular surgery were associated with higher risk of re-amputation.
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Gürsan, Onur, Mustafa Çeltik, and Cihangir Türemiş. "Predisposal factors leading to early re-amputation among diabetic patients who underwent minor amputation." Journal of Surgery and Medicine 7, no. 8 (August 30, 2023): 514–17. http://dx.doi.org/10.28982/josam.7933.
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Background/Aim: Prolonged wound complications and the possibility of reoperations are significant outcomes following minor amputations. As time progresses after the initial surgery, re-amputations become more prevalent. Contrary to prevailing beliefs, the incidence of early amputations remains consistent. Additionally, it is widely acknowledged that the first 6 months following the initial surgery pose the highest risk period for reoperation. This retrospective clinical study aims to investigate the risk factors contributing to ipsilateral re-amputation procedures within 6 months of the initial minor amputation. Methods: A retrospective cohort study was conducted involving amputee patients from 2008 to 2020. Patients with traumatic events, musculoskeletal tumors, prior major amputations, and those who underwent soft tissue procedures such as debridement, incision, drainage, or secondary closure were excluded. Patients who had undergone preoperative lower limb arterial Doppler ultrasound and whose initial preoperative laboratory records were accessible were included. The total cohort comprised 168 patients, comprising 57 women and 109 men. The mean follow-up duration was 1.5 years (range: 1.1–3.2 years). Patients who underwent ipsilateral re-amputation were categorized into two groups based on the timing of the subsequent surgery. The first group comprised 110 (65.5%) patients who underwent ipsilateral re-amputation 6 months after the initial amputation, while the second group encompassed 58 (34.5%) patients who underwent ipsilateral re-amputation within 6 months of the initial amputation. Results: Among the 168 patients, 58 (34.5%) experienced ipsilateral re-amputation within 6 months of their initial minor amputations, while 64.5% underwent re-amputation surgery after the initial 6 months. The absence of peripheral arterial disease was not linked to early re-amputations (P=0.001). Although the mean C-reactive protein values (80.30 mg/dL and 84.26 mg/dL for groups 1 and 2, respectively) did not display significance between the groups (P=0.40), the group undergoing amputation within 6 months demonstrated significance with elevated serum white blood cell mean levels (10.44 mcL and 11.96 mcL for groups 1 and 2, respectively; [P=0.004]). Moreover, lower hemoglobin levels (11.41 g/dL and 10.77 g/dL for groups 1 and 2, respectively) were associated with re-amputation within the initial 6 months following the initial surgery (P=0.024). Conclusion: The study underscores that the incidence of re-amputation after minor amputations in diabetic patients is comparably high, as has been reported in recent literature. While the selection of the initial amputation level remains pivotal, and not all patient-specific factors were examined in this study, the research brings attention to specific laboratory values and the vascular status of the diabetic limb as crucial considerations for surgeons prior to the initial surgery.
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Tosun, Bilgehan, Levent Buluc, Umit Gok, and Cigdem Unal. "Boyd Amputation in Adults." Foot & Ankle International 32, no. 11 (November 2011): 1063–68. http://dx.doi.org/10.3113/fai.2011.1063.
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Background: Foot ulcerations resulting in amputation are one of the most devastating consequences of diabetes mellitus and peripheral arterial disease. In foot amputations, Boyd amputation has been even less accepted than Syme amputation due to its dependence on calcaneotibial osseous union in adults. Methods: Fifteen Boyd amputations were performed for 14 adults. The indications for amputation were diabetic ulceration of the foot in eight patients, ischemic disease of the lower extremity in four and salvage of the deformed foot due to peripheral neuropathy in one patient. One patient with scleroderma had bilateral amputations due to digital ischemic necrosis. Results: Complete wound healing was documented in seven feet of six patients. Further revisions to a more proximal amputation level were required in seven patients. Conclusion: Despite the high failure rate, we believe Boyd amputation is still a good option in some patients to try to preserve length. Level of Evidence: IV, Retrospective Case Series
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Williams, Zachary F., Lindsay M. Bools, Ashley Adams, Thomas V. Clancy, and William W. Hope. "Early versus Delayed Amputation in the Setting of Severe Lower Extremity Trauma." American Surgeon 81, no. 6 (June 2015): 564–68. http://dx.doi.org/10.1177/000313481508100618.
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Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1,2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.
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Durusoy, R., A. Davas, M. Kayalar, E. Bal, F. Aksu, and S. Ada. "What kinds of hand injuries are more likely to result in amputation? An analysis of 6549 hand injuries." Journal of Hand Surgery (European Volume) 36, no. 5 (March 15, 2011): 383–91. http://dx.doi.org/10.1177/1753193411400520.
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We analysed 6549 hand injuries treated between 1992 and 2005 at a specialist hospital in Turkey to identify risk factors for amputations. There were 2899 (44%) hand amputations. Left-side injuries were more prone to amputation. The risk of amputation was higher in men, workers and those in the 15–24 and 45–54 year-old age groups. Compared to home, commercial areas were the places with highest risk, followed by farms and industrial/construction areas. The majority of amputations occurred in industrial/construction areas (87%). Among objects/substances producing injury, watercraft led to the highest risk of amputation and contact with machinery was the mechanism with highest risk. Press machines were the most frequent objects causing amputation both in men and women, followed almost equally by powered wood cutters in men. Doors were the most frequent objects of amputation in children, followed by powered wood cutters. Education, enforcement, and improved engineering are the keys to prevent amputations. Precluding illegal child labour is essential.
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Rogers, Lee C., and Nicholas J. Bevilacqua. "Organized Programs to Prevent Lower-Extremity Amputations." Journal of the American Podiatric Medical Association 100, no. 2 (March 1, 2010): 101–4. http://dx.doi.org/10.7547/1000101.
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Background: Diabetes-related lower-extremity amputations are largely preventable. Eighty-five percent of amputations are preceded by a foot ulcer. Effective management of ulcers, which leads to healing, can prevent limb loss. Methods: In a county hospital, we implemented a six-step approach to the diabetic limb at risk. We calculated the frequency and level of lower-extremity amputations for 12 months before and 12 months after implementation of the amputation prevention program. We also calculated the high-low amputation ratio for the years reviewed. The high-low amputation ratio is a quality measure for the success of amputation prevention measures and is calculated as the ratio of the number of high amputations (limb losses) over the number of low (partial foot) amputations. Results: The frequency of total amputations increased from 24 in year 1 to 46 in year 2. However, the number of limb losses decreased from 7 to 2 (72%). The high-low amputation ratio decreased eightfold in 1 year, which serves as a marker for limb salvage success. Conclusions: Improvement in care organization and multidisciplinary-centered protocols can substantially reduce limb losses. (J Am Podiatr Med Assoc 100(2): 101–104, 2010)
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Berli, Martin C., Florian Wanivenhaus, Method Kabelitz, Tobias Götschi, Thomas Böni, Zoran Rancic, and Felix W. A. Waibel. "Predictors for reoperation after lower limb amputation in patients with peripheral arterial disease." Vasa 48, no. 5 (August 1, 2019): 419–24. http://dx.doi.org/10.1024/0301-1526/a000796.
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Summary. Background: Major amputations in patients with peripheral arterial disease (PAD) carry a high risk for complications, including revision of the amputation, sometimes to a higher level. Determining a safe level for amputation with good wound healing potential depends largely on vascular measurements. This study evaluated potential predictive factors for revision of major lower extremity amputations in patients with PAD. Patients and methods: A retrospective chart review of all major lower extremity amputations at our institution was conducted. Amputations due to trauma or tumor and below-ankle amputations were excluded. Patient demographics, level/type of amputation, level/time of revision, comorbidities and risk factors were extracted. Results: 180 patients with PAD, mean age 66.48 (range: 31–93) years, 125 (69.4%) male were included. Most (154/180, 86.6%) underwent below-knee amputation. 71 (39.4%) patients had coronary arterial disease, 104 (57.8%) had diabetes. More than half of patients, (93/138; 51.7%) had undergone previous balloon angioplasty. 44 (30%) patients required revision surgery: 42/180 (23.3%) were revised at the same level, and in 12/180 (6.7%) a more proximal amputation was necessary. PAD stage was not associated with the level of reamputation (p = 0.4369). Significantly more patients who had previous balloon angioplasty required revision surgery (66.7% versus 45.2%, p = 0.009). 67 (37.2%) patients underwent preoperative TcPO2 measurement: 40/67 (59.7%) had TcPO2 ≥ 40 mmHg; 4/67 (6%) had TcPO2 < 10 mmHG. Three patients with TcPO2 ≥ 40 mmHg, one with 30 mmHg ≤ TcPO2 ≤ 40 mmHg and one with 10 mmHg ≤ TcPO2 ≤ 20 mmHg required re-amputation to a more proximal level. Conclusions: TcPO2 measurements are useful for determining level of lower limb amputation and predicting wound healing problems when an amputation level with TcPO2 < 40 mmHg is chosen. In transtibial amputations, TcPO2 ≥ 40 mmHg does not safely predict wound healing.
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Buryanov, A. A., A. A. Bespalenko, Ie V. Tsema, and A. V. Dinets. "LIMB AMPUTATIONS IN MILITARY PERSONNEL DUE TO ARTILLERY STRIKES IN THE AREA OF THE ANTITERRORIST OPERATION (ATO) IN EAST UKRAINE." Ukrainian Scientific Medical Youth Journal 103, no. 3 (September 23, 2017): 15–19. http://dx.doi.org/10.32345/usmyj.3(103).2017.15-19.
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The aim – to investigate and evaluate amputations of extremities due to the trikes of artillery against military personnel of the Armed Forces of Ukraine (AFU) within the area of the Antiterrorist Operation (ATO) in East Ukraine.
Patients and methods. All military personnel of the AFU within ATO was eligible for the study with diagnosis of limb amputations in the period from 01.06.2014 to 30.06.2016, and who were treated in hospitals of the Ministry of Defense of Ukraine. Among 7091 patients with injuries, 152 patients with limb amputations were identified.
Results and discussion. Out of 152 patients, 73 (48%) amputations were due to artillery strikes or mine shelling, while other causes of amputation were identified in 79 (52%) of the wounded. Amputations of the middle 1/3 of the arm were more frequently diagnosed in the artillery injury group as compared to the group of another cause of amputation (p = 0.011). The use of artillery by the terrorists against the AFU resulted in more often in amputation of one limb, which was detected in 70 (96%) patients in this group, as compared with 65 (82%) patients in the group of another cause of amputation (p = 0.0093). Analyses of the number of amputated extremities revealed 1 (1.4%) patient with amputation of 2 lower extremities in the artillery fire group, which was 9 times less frequently observed as compared to 9 (11%) patients in the group of another cause of amputation (p = 0.019).
Conclusions: The results of the study confirmed significant role of artillery strikes for the amputation of one limb. High-energy artillery weapons play a minor role in terms of amputations at the level of the middle 1/3 of the upper limb and amputation of the two lower limbs.
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Bespalenko, A. A., A. A. Buryanov, Ie V. Tsema, and A. V. Dinets. "LIMBS REAMPUTATIONS IN MILITARY PERSONNEL INJURED IN THE AREA OF THE ANTITERRORIST OPERATION IN EAST UKRAINE." Ukrainian Scientific Medical Youth Journal, no. 1(105) (September 14, 2018): 5–10. http://dx.doi.org/10.32345/usmyj.1(105)().2018.5-10.
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The aim – to identify and analyze causes for reamputations in military personnel with limb amputations due to ATO in East Ukraine. Patients and methods. All military personnel of the AFU within ATO was eligible for the study with diagnosis of limb amputations in the period from 01.06.2014 to 30.06.2016, and which were treated in hospitals of the Ministry of Defense of Ukraine. Among 7091 patients with injuries, 152 patients with limb amputations were identified.
Results and discussion. Out of 152 patients, 25 (16%) underwent limbs reamputation, whereas 127 (84%) patients underwent amputation once. Patients in the study groups did not differ in age. Amputation was performed on the upper limb in 41 (32%) in the group of patients with amputations, which is significantly higher as compared to 2 (8%) patients in the reamputation group (p = 0.014). Analyses the level of amputations of the upper extremity showed no difference in the parameters. In 23 (92%) patients in the group with reamputation amputation of the lower limbs were diagnosed significantly more often as compared to 86 (68%) patients in the amputation group (p = 0.014). Analyses of the level of amputation of the lower extremity revealed that almost 3 times more often amputation was performed at the level of the ankle in the group of patients with reputations - 8 (32%) patients, as compared to 15 (12%) patients in the amputation group (p = 0.03). However, linear regression did not show a significant difference of these parameters in reamputations. Amputation of one upper extremity in the reamputation group was diagnosed 7 times less frequent - 1(4%) patient less often than in the amputation group - 37(29%) patients (p = 0.005).
Conclusions: The results of the study of the injured in a hybrid war indicate that reamputations are more often associated with amputations at the level of the upper limb, but are less often diagnosed in patients with amputation of the lower extremity. Reamputations are more often performed with trauma of one limb. Clinical features in patients injured in the ATO zone in the East Ukraine demonstrate the frequency and characteristics of re-arrests that are different from other armed conflicts.
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Bespalenko, А. А., А. А. Buryanov, Ie V. Tsema, and A. V. Dinets. "LIMBS REAMPUTATIONS IN MILITARY PERSONNEL INJURED IN THE AREA OF THE ANTITERRORIST OPERATION IN EAST UKRAINE." Ukrainian Scientific Medical Youth Journal 105, no. 1 (March 31, 2018): 5–10. http://dx.doi.org/10.32345/usmyj.1(105).2018.5-10.
Full textAbstract:
The aim – to identify and analyze causes for reamputations in military personnel with limb amputations due to ATO in East Ukraine. Patients and methods. All military personnel of the AFU within ATO was eligible for the study with diagnosis of limb amputations in the period from 01.06.2014 to 30.06.2016, and which were treated in hospitals of the Ministry of Defense of Ukraine. Among 7091 patients with injuries, 152 patients with limb amputations were identified.
Results and discussion. Out of 152 patients, 25 (16%) underwent limbs reamputation, whereas 127 (84%) patients underwent amputation once. Patients in the study groups did not differ in age. Amputation was performed on the upper limb in 41 (32%) in the group of patients with amputations, which is significantly higher as compared to 2 (8%) patients in the reamputation group (p = 0.014). Analyses the level of amputations of the upper extremity showed no difference in the parameters. In 23 (92%) patients in the group with reamputation amputation of the lower limbs were diagnosed significantly more often as compared to 86 (68%) patients in the amputation group (p = 0.014). Analyses of the level of amputation of the lower extremity revealed that almost 3 times more often amputation was performed at the level of the ankle in the group of patients with reputations - 8 (32%) patients, as compared to 15 (12%) patients in the amputation group (p = 0.03). However, linear regression did not show a significant difference of these parameters in reamputations. Amputation of one upper extremity in the reamputation group was diagnosed 7 times less frequent - 1(4%) patient less often than in the amputation group - 37(29%) patients (p = 0.005).
Conclusions: The results of the study of the injured in a hybrid war indicate that reamputations are more often associated with amputations at the level of the upper limb, but are less often diagnosed in patients with amputation of the lower extremity. Reamputations are more often performed with trauma of one limb. Clinical features in patients injured in the ATO zone in the East Ukraine demonstrate the frequency and characteristics of re-arrests that are different from other armed conflicts.
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Jandric, Slavica, and Brano Topic. "Effect of primary and secondary wartime below-knee amputation on length of hospitalization and rehabilitation." Vojnosanitetski pregled 59, no. 3 (2002): 261–64. http://dx.doi.org/10.2298/vsp0203261j.
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The results of below-knee amputations in 36 war wounded (mean age 35,42) were reviewed. The majority of the patients was wounded by land mines (94.4%). Most of them were between 25 and 35 years old. Bilateral amputation was done in 2.8% of cases. The amputation was performed on the day of wounding (primary below-knee amputation) in 30 (83.3%) amputees. Secondary amputation after the attempt to save the severely injured lower-limb was performed in 6 patients (16,7%) average 4.61 ? 11.67 days after wounding. Reamputation was necessary in 6 cases (16.7%). Time period from the beginning of rehabilitation to the fitting of prosthesis, was 36.25 ? 14.97 days for primary amputations, 32 ? 17.8 days for secondary amputations and 68.66 ? 33.52 days for reamputations. There was no significant correlation between the duration of rehabilitation to prosthetic management and the period between wounding and amputation (r = -0.102). The attempt to save the limb after severe below-knee injuries and the secondary amputation afterwards, did not significantly influence the ensuing rehabilitation and prosthetic works.
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Ebskov, L. B. "Level of lower limb amputation in relation to etiology: An epidemiological study." Prosthetics and Orthotics International 16, no. 3 (December 1992): 163–67. http://dx.doi.org/10.3109/03093649209164335.
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The Danish Amputation Register and the nationwide National Patient Register are presented. Based upon the code numbers in the WHO classification system (ICD), 4 etiology groups i.e. vascular insufficiency, diabetes mellitus, malignant neoplasma and trauma were extracted. The purpose was to analyse the relationship between level of amputation (i.e. foot, below-knee, through-knee, above-knee and hip) and etiology (cause of amputation). The material represents all such amputations in Denmark during the period 1978 to 1989 (n=25.767). The number of amputations because of vascular insufficiency with and without diabetes mellitus decreased over the period studied. The number of tumour and trauma amputations seemed unchanged. There was a significant reduction in the number of amputations at proximal levels (above-knee) for vascular insufficiency with and without diabetes mellitus and in the trauma group. No such change was found regarding tumour amputations. There was a characteristic pattern in the distribution of level respectively of etiological factors for each etiology group and for each level of amputation.
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Chung, Hyung-Jin, Dong-Il Chun, Eun Myeong Kang, Keonwoo Kim, Jinyoung Lee, Ye Jin Jeon, Jaeho Cho, Sungho Won, and Young Yi. "Trend and Seasonality of Diabetic Foot Amputation in South Korea: A Population-Based Nationwide Study." International Journal of Environmental Research and Public Health 19, no. 7 (March 30, 2022): 4111. http://dx.doi.org/10.3390/ijerph19074111.
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The number of lower extremity amputations in diabetic foot patients in Korea is increasing annually. In this nationwide population-based retrospective study, we investigated the data of 420,096 diabetes mellitus patients aged ≥18 years using the Korean Health Insurance Review and Assessment Service claim database. We aimed to study the seasonal and monthly trends in diabetic foot amputations in Korea. After applying the inclusion criteria, 8156 amputation cases were included. The analysis showed an increasing trend in monthly amputation cases. In terms of seasonality, the monthly frequency of amputation was commonly observed to be lower in February and September every year. Diabetic foot amputations frequently occurred in March, July, and November. There was no difference between the amputation frequency and mean temperature/humidity. This study is meaningful as it is the first nationwide study in Korea to analyze the seasonal and monthly trends in diabetic foot amputation in relation to climatic factors. In conclusion, we recognize an increased frequency of amputation in March, July, and November and recommend intensive educational program on foot care for all diabetes patients and their caregivers. This could improve wound management and amputation prevention guidelines for diabetic foot patients in the Far East with information on dealing with various seasonal changes.
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SOOMRO, NABILA, RUKHSANA BIBI, SYED IMRAN AHMED, Brigitte Kamran, Muhammad Ali Minhas, and Kamran Yousuf Siddiqui. "EPIDEMIOLOGY OF AMPUTATION;." Professional Medical Journal 20, no. 02 (February 7, 2013): 261–65. http://dx.doi.org/10.29309/tpmj/2013.20.02.685.
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Amputation is stated to be a foremost but preventable community health problem causing intense financial, social andemotional effects on the patient and family particularly in developing countries where the prosthetic services are limited. The purpose ofthis study was to identify the causes and levels of amputation in low resource community, Sindh Pakistan. Methods: This was aretrospective chart review study that was carried out at first civilian Institute of physical medicine & rehabilitation-Dow University of healthsciences from October 2007 to June 2012. After verbal informed consent all patients, who underwent major or minor amputation wereenrolled for the study. Data was collected using a pre-tested, coded questionnaire and analysed using SPSS version 16. Results: A total of1115 patients were enrolled into the study. Their ages were ranged between 2–95 years (mean 38.40±17.38). Among total population ofamputees 83.58% were males. The most common cause for major limb amputation was road Traffic accident 38.38%, followed byDiabetes 15.42%, infection 14.26% and trauma 12.37%. Lower limbs (trans-tibial) amputations were in 47.35% of cases and transfemoralin 27.98% of cases. While for the upper limb trans-radial amputation (7.4%) were found to be more common than trans-humeral(5.56%). Other amputations were for shoulder, hip and knee disarticulations. Conclusions: Road traffic accidents, complications ofdiabetic foot ulcers, infections and trauma were the most common causes for major limb amputations found in low resource community,Sindh Pakistan. The majority of these amputations are preventable by endowment of traffic rules, health education, early preventions andappropriate management of the common infections.
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Heikkinen, M., J. Saarinen, V. P. Suominen, J. Virkkunen, and J. Salenius. "Lower limb amputations: Differences between the genders and long-term survival." Prosthetics and Orthotics International 31, no. 3 (September 2007): 277–86. http://dx.doi.org/10.1080/03093640601040244.
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The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 – 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men ( p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 106 inhabitants/year) ( p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women ( p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.
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Yu, Justin, Jai Joshi, Carmen Wong, Nafis Ahmed, Amit Rao, Timmy Li, Ammar Al Rubaiay, Gregg Landis, and Alisha Oropallo. "Lessons Learned: A Disruption in Care Leads to Increased Rates of Proximal Amputations." Wound Management & Prevention 69, no. 1 (March 1, 2023): 49–57. http://dx.doi.org/10.25270/wmp.2023.1.4957.
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BACKGROUND: In March 2020, due to the COVID-19 pandemic, hospitalizations in New York state were restricted to emergency purposes. Non-COVID related cases involving lower extremity wounds were only admitted for acute infections and limb salvage. Patients with these conditions were placed at higher risk for eventual limb loss. PURPOSE: To understand the impact of COVID-19 on amputation rates. METHODS: A retrospective review of lower limb institution-wide amputations was conducted at Northwell Health from January 2020 to January 2021. The amputation rates during the COVID-19 shutdown period were compared to the pre-pandemic, post-shutdown, and reopening period. RESULTS: The pre-pandemic period had 179 amputations, of which 8.38% were proximal. 86 amputations were performed during shutdown, with a greater proportion being proximal (25.58%, p=0.0009). Following the shutdown period, amputations returned to baseline. The proportion of proximal amputations during post-shutdown was 18.5% and during reopening was 12.06%. Patients had 4.89 times higher odds of undergoing a proximal amputation during the shutdown period. CONCLUSIONS: The effect of COVID-19 on amputation rates demonstrates an increase in proximal amputation during the initial shutdown. This study suggests an indirect negative effect of COVID-19 hospital restrictions on surgeries during the initial shutdown period.
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Vasudeva, Varun, Adam Parr, Alan Loch, and Chris Wall. "What happens to our amputees? The Darling Downs experience." Journal of Orthopaedic Surgery 28, no. 3 (May 1, 2020): 230949902095847. http://dx.doi.org/10.1177/2309499020958477.
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Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.
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Sunil, Thankam, Amanda Limon, and Lyssa Ochoa. "Lower Extremity Amputation among Diabetic Patients in San Antonio, Texas." Hispanic Health Care International 17, no. 2 (February 21, 2019): 73–78. http://dx.doi.org/10.1177/1540415319828267.
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Background: In the United States, ethnic minorities are disproportionately affected by diabetes-related lower extremity amputations (LEA) and have higher associated mortality rates than non-Hispanic Whites. Bexar County, a county in south Texas, had higher diabetes rates than both Texas and the national average. Bexar County also had one of the highest LEA hospital admission rates in the State. Aim: Elucidate diabetes-related LEA factors to assist policy makers and health professionals develop more effective interventions. Results: For participants who had more than one amputation, the time between amputations was approximately 1 year. Hispanics endorsed more diabetic health beliefs than non-Hispanic Whites. Participants 64 and younger reported greater social support and greater depression symptomatology than participants 65 and older. Participants with an amputation reported greater ability to engage in activities that would manage their diabetes than participants without an amputation. Participants without an amputation reported greater concern of their general health than participants with an amputation. Conclusion: The present study demonstrated the necessity for more research on diabetic amputation and related depression among Hispanics. The study also highlighted the need to create culturally appropriate interventions to reduce the rate and frequency of additional amputations.
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Yuzuguldu, Burak, Bugra Zengin, Ilgin Yildirim Simsir, and Sevki Cetinkalp. "An Overview of Risk Factors for Diabetic Foot Amputation: An Observational, Single-centre, Retrospective Cohort Study." European Endocrinology 19, no. 1 (2023): 85. http://dx.doi.org/10.17925/ee.2023.19.1.85.
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Introduction: Not only are early detection and treatment of diabetic foot ulcers important, but also acknowledging potential risk factors for amputation gives clinicians a considerable advantage in preventing amputations. Amputations impact both healthcare services and the physical and mental health of patients. This study aimed to investigate the risk factors for amputation in patients with diabetic foot ulcers. Methods: The sample for this study was patients with diabetic foot ulcers who were treated by the diabetic foot council at our hospital between 2005 and 2020. A total of 32 risk factors for amputation were identified and investigated among 518 patients. Results: Our univariate analysis showed that 24 of 32 defined risk factors were statistically significant. In the multivariate analysis using the Cox regression model, seven risk factors remained statistically significant. The risk factors most significantly associated with amputation were Wagner grading, abnormal peripheral arteries, hypertension, high thrombocyte levels, low haematocrit levels, hypercholesterolaemia and male sex, respectively. The most common cause of death in patients with diabetes who have undergone amputation is cardiovascular disease, followed by sepsis. Conclusion: To enable optimum treatment of patients with diabetic foot ulcers it is important for physicians to be aware of the amputation risk factors, and thus avoid amputations. Correcting risk factors, using suitable footwear and routinely inspecting feet are crucial factors for preventing amputations in patients with diabetic foot ulcers.
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JENSEN, C. M., M. HAUGEGAARD, and S. W. RASMUSSEN. "Amputations in the Treatment of Dupuytren’s Disease." Journal of Hand Surgery 18, no. 6 (December 1993): 781–82. http://dx.doi.org/10.1016/0266-7681(93)90245-b.
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23 finger amputations in 19 patients operated on for Dupuytren’s disease were reviewed 6 months to 8.5 years after operation (mean 4 years). The distribution of amputations were 17 little fingers and six ring fingers. We found a recurrent lack of extension in nine out of 16 finger amputations distal to the MP joint and painful neuroma or phantom limb pain in five out of seven little finger amputations through or proximal to the MP joint. When amputation in the little finger is necessary, disarticulation of the MP joint may be preferable to amputation at a more distal level. Alternatives to finger amputation should be sought in difficult cases of Dupuytren’s disease.
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Brauckmann, Vesta, Ole Moritz Block, Luis A. Pardo, Wolfgang Lehmann, Frank Braatz, Gunther Felmerer, Sebastian Mönnighoff, and Jennifer Ernst. "Can Early Post-Operative Scoring of Non-Traumatic Amputees Decrease Rates of Revision Surgery?" Medicina 60, no. 4 (March 30, 2024): 565. http://dx.doi.org/10.3390/medicina60040565.
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Background and Objectives: Medical registries evolved from a basic epidemiological data set to further applications allowing deriving decision making. Revision rates after non-traumatic amputation are high and dramatically impact the following rehabilitation of the amputee. Risk scores for revision surgery after non-traumatic lower limb amputation are still missing. The main objective was to create an amputation registry allowing us to determine risk factors for revision surgery after non-traumatic lower-limb amputation and to develop a score for an early detection and decision-making tool for the therapeutic course of patients at risk for non-traumatic lower limb amputation and/or revision surgery. Materials and Methods: Retrospective data analysis was of patients with major amputations lower limbs in a four-year interval at a University Hospital of maximum care. Medical records of 164 patients analysed demographics, comorbidities, and amputation-related factors. Descriptive statistics analysed demographics, prevalence of amputation level and comorbidities of non-traumatic lower limb amputees with and without revision surgery. Correlation analysis identified parameters determining revision surgery. Results: In 4 years, 199 major amputations were performed; 88% were amputated for non-traumatic reasons. A total of 27% of the non-traumatic cohort needed revision surgery. Peripheral vascular disease (PVD) (72%), atherosclerosis (69%), diabetes (42%), arterial hypertension (38%), overweight (BMI > 25), initial gangrene (47%), sepsis (19%), age > 68.2 years and nicotine abuse (17%) were set as relevant within this study and given a non-traumatic amputation score. Correlation analysis revealed delayed wound healing (confidence interval: 64.1% (47.18%; 78.8%)), a hospital length of stay before amputation of longer than 32 days (confidence interval: 32.3 (23.2; 41.3)), and a BKA amputation level (confidence interval: 74.4% (58%; 87%)) as risk factors for revision surgery after non-traumatic amputation. A combined score including all parameters was drafted to identify non-traumatic amputees at risk for revision surgery. Conclusions: Our results describe novel scoring systems for risk assessment for non-traumatic amputations and for revision surgery at non-traumatic amputations. It may be used after further prospective evaluation as an early-warning system for amputated limbs at risk of revision.
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Ohmine, Saburo, Yoshiko Kimura, Satoru Saeki, and Kenji Hachisuka. "Community-based survey of amputation derived from the physically disabled person’s certification in Kitakyushu City, Japan." Prosthetics and Orthotics International 36, no. 2 (February 7, 2012): 196–202. http://dx.doi.org/10.1177/0309364611433443.
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Background: There were no recent reports of community-based surveys on the incidence, level and causes of amputation in Japan.Objectives: To identify any changes in the incidence, level, causes of amputation and gender distribution.Study Design: A community-based survey.Methods: The subjects were Kitakyushu-citizens amputated between 2001 and 2005 and selected based on medical certificates for the physically disabled person’s certificate.Results: The incidence of amputation (/100,000 population per year) was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs. The average age at amputation was 63.5 ± 20.1 years and the male:female ratio was 1.9:1. The most frequent levels of amputations were partial hand amputation (84.4%) for upper limbs, and transtibial amputation (42.3%) and transfemoral amputation (36.8%) for lower limbs. The major causes were injuries (54.3%) for upper limbs, and peripheral vascular disorder (49.0%) and diabetes mellitus with peripheral circulatory complications (28.6%) for lower limbs.Conclusions: The incidence of amputation was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs, and the male:female ratio was 1.9:1. In comparison to a previous survey the percentages of amputation due to peripheral circulatory disorders and injuries increased and decreased, respectively, and the rate of female amputations increased.Clinical relevanceThis study provides useful data about change of the recent epidemiology of amputation in Kitakyushu, Japan. These data are essential to perform clinical practices in amputation rehabilitation, including prescription of prosthesis, general fatigue for aged amputees, and complication of peripheral circulatory disorders.
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Fahim Sakhizada, Muhammad Aqib, Aliya Shaima, Fatima Shahzad, Fahad Akhtar, and S H Waqar. "Outcome of Lower Limb Amputation Performed in General Surgery Department." Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 20, no. 3 (June 11, 2024): 304–8. http://dx.doi.org/10.48036/apims.v20i3.1127.
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Objective: To evaluate the outcomes of lower extremity amputation at a tertiary care hospital in Pakistan. Methodology: This cross-sectional study was conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad for two years. All adult patients who underwent any form of lower limb amputation were included in the study. The data regarding their demographics, risk factors, indications of amputation, type of amputation and outcome was collected from patients on a prescribed proforma and were analyzed using SPSS version 22. Results: There were a total of 73 patients with 45 (61.6%) men and 28 (38.4%) women. The mean age was 57.3±13.7 years. The most common indication for amputation (69.8%) was diabetic foot gangrene. The most common level of amputation (45.2%) was below knee amputation and 21.9% had above knee amputation. The majority (83.6%) were admitted through the emergency department. Hypertension (72.6%) and smoking (46.6%) were the most common risk factors among the participants. The most common comorbidity reported was Diabetes Mellitus (65.8%) followed by Peripheral artery disease (41.1%). Pain and Mobility both improved after amputation. Conclusion: Lower extremity amputations are done mainly in patients with diabetes and peripheral artery diseases. Diabetes Mellitus, hypertension and PAD were the commonest comorbidities identified among them. Below knee amputation is the most common procedure followed by ray amputation. Postoperative patients have improved mobility and pain relief. In many cases, significant amputations can be avoided with the help of public awareness, education, and prompt health care seeking.
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Al-Thani, Hassan, Brijesh Sathian, and Ayman El-Menyar. "Assessment of healthcare costs of amputation and prosthesis for upper and lower extremities in a Qatari healthcare institution: a retrospective cohort study." BMJ Open 9, no. 1 (January 2019): e024963. http://dx.doi.org/10.1136/bmjopen-2018-024963.
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ObjectivesTo evaluate the healthcare cost of amputation and prosthesis for management of upper and lower extremities in a single institute.DesignRetrospective cohort study conducted between 2000 and 2014.ParticipantsAll patients who underwent upper (UEA) and lower extremities amputation (LEA) were identified retrospectively from the operating theatre database. Collected data included patient demographics, comorbidities, interventions, costs of amputations including hospitalisation expenses, length of hospital stay and mortality.Outcome measuresIncidence, costs of amputation and hospitalisation according to the level of the amputation and cost per bed days, length of hospital stay and mortality.ResultsA total of 871 patients underwent 1102 (major 357 and minor 745) UEA and LEA. The mean age of patients was 59.4±18.3, and 77.2% were males. Amputations were most frequent among elderly (51.1%). Two-third of patients (75.86%, 95% CI 72.91% to 78.59%) had diabetes mellitus. Females, Qatari nationals and non-diabetics were more likely to have higher mean amputation and hospital stay cost. The estimated total cost for major and minor amputations were US$3 797 930 and US$2 344 439, respectively. The cumulative direct healthcare cost comprised total cost of all amputations, bed days cost and prosthesis cost and was estimated to be US$52 126 496 and per patient direct healthcare procedure cost was found to be US$59 847. The total direct related therapeutic cost was estimated to be US$26 096 046 with per patient cost of US$29 961. Overall per patient cost for amputation was US$89 808.ConclusionsThe economic burden associated with UEA and LEA-related hospitalisations is considerable. Diabetes mellitus, advanced age and sociodemographic factors influence the incidence of amputation and its associated healthcare cost. The findings will help to showcase the economic burden of amputation for better management strategies to reduce healthcare costs. Furthermore, larger prospective studies focused on cost-effectiveness of primary prevention strategies to minimise diabetic complication are warranted.
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Baidoo, R. O., and S. Debrah. "Major Extremity Amputation: The Koforidua Experience." Postgraduate Medical Journal of Ghana 5, no. 2 (July 12, 2022): 68–70. http://dx.doi.org/10.60014/pmjg.v5i2.161.
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Background: Major extremity amputation is a relatively common surgical procedure but there is a paucity of local data concerning such an important part of surgical practice. This study was undertaken to unearth the demographics, the common indications, levels, revision and mortality rates of major extremity amputation in a large orthopaedic facility in Ghana.Methods: A retrospective study of 94 consecutive patients with 95 major limb amputations between September 2010 to August 2013 was conducted and the results analysed.Results: Overall, the commonest indication for amputation was trauma which was responsible for 44(46.3%) cases. Of the 95 amputations, 81(85.3%) were lower limb amputations with below knee amputations accounting for 45(47.3%) cases. The age group 21 – 40years had the highest number of amputations with 38(40%) and the commonest cause in this age group was trauma. Average duration of hospitalization was 32 days with 8 patients (8.4%) requiring re-amputation. Six patients (6.4%) died.Conclusion: Major limb amputation is drastically life altering especially in third world countries where livelihoods may depend on the ability to perform manual tasks and opportunities for changes in career paths/gainful rehabilitation do not abound. If traumaticconditions are prevented and expeditiously dealt with and chronic diseases like diabetes are carefully managed, there will be a significant reduction in limb loss following trauma or diabetic foot syndrome.
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Lakstein, Dror, Alexander Lipkin, Louis Schorr, and Zeev Feldbrin. "Primary Closure of Elective Toe Amputations in the Diabetic Foot—Is it Safe?" Journal of the American Podiatric Medical Association 104, no. 4 (July 1, 2014): 383–86. http://dx.doi.org/10.7547/0003-0538-104.4.383.
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Background Toe amputation is the most common partial foot amputation. Controversy exists regarding whether to primarily close toe amputations or to leave them open for secondary healing. The purpose of this study was to evaluate the results of closed toe amputations in diabetic patients, with respect to wound healing, complications, and the need for further higher level amputation. Methods We retrospectively reviewed the results of 40 elective or semi-elective toe amputations with primary closure performed in 35 patients treated in a specialized diabetic foot unit. Patients with abscesses or necrotizing fasciitis were treated emergently and were excluded. Patients in whom clean margins could not be achieved due to extensive cellulitis or tenosynovitis and patients requiring vascular intervention were excluded as well. Outcome endpoints included wound healing at 3 weeks, delayed wound healing, or subsequent higher level amputation. Results Out of 40 amputations, 38 healed well. Thirty amputations healed by the time of stitch removal at 3 weeks and eight had delayed healing. In two patients the wounds did not heal and subsequent higher level amputation was eventually required. Conclusions In carefully selected diabetic foot patients, primary closure of toe amputations is a safe surgical option. We do not recommend primary closure when infection control is not achieved or in patients requiring vascular reconstruction. Careful patient selection, skillful assessment of debridement margins and meticulous technique are required and may be offered by experienced designated surgeons in a specialized diabetic foot unit.
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Takeuchi, Hisataka, Ryosuke Ikeguchi, Mutsumi Watanabe, Tadashi Yasuda, and Shuichi Matsuda. "Postoperative Evaluation of Patient Satisfaction and Tingling Sensation after Replantation Surgery without Nerve Repair for Complete Digital Amputation." Journal of Reconstructive Microsurgery Open 02, no. 01 (January 2017): e19-e22. http://dx.doi.org/10.1055/s-0037-1598249.
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Background When performing replantation surgery for complete fingertip amputation, we do not perform digital nerve repair. We hypothesized that this method would not decrease patient satisfaction. Methods Between July 2011 and August 2013, we performed replantation surgery for 21 complete digital amputations in 18 patients. Digital nerves were not repaired for fingertip amputations. For proximal to distal interphalangeal joint amputations (proximal amputation), however, we repaired as many digital nerves as possible. We followed 17 replanted fingers in 14 patients (fingertip, 9 fingers in 9 patients; proximal, 8 fingers in 5 patients) for > 1 year, performing retrospective evaluation of subjective outcomes via telephone surveys. Patient satisfaction and fingertip tactile sensation scores (FTSS) were rated on scales of 0 to 10; unpleasant sensations (paresthesia or dysesthesia) were also surveyed. Results Mean patient satisfaction was significantly greater in the fingertip-amputation group than in the proximal-amputation group (9.4 and 7.6, respectively), although mean FTSS did not show significant difference (6.0 and 3.6, respectively). Patients with proximal amputations had dysesthesia in three fingers, paresthesia in one finger, and no numbness in four fingers, whereas patients with fingertip amputations had dysesthesia in three fingers, paresthesia in four fingers, and no numbness in two fingers. Patients with fingertip amputation had significantly more unpleasant sensation than those with proximal amputations. Conclusion Although fingertip replantation without digital nerve repair causes postoperative tingling, it results in good patient satisfaction.
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CHANG, J., and N. F. JONES. "Simultaneous Toe-to-Hand Transfer and Lower Extremity Amputations for Severe Upper and Lower Limb Defects: The Use of Spare Parts." Journal of Hand Surgery 27, no. 3 (June 2002): 219–23. http://dx.doi.org/10.1054/jhsb.2001.0735.
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From 1995 to 2000, five microvascular toe-to-hand transfers were performed in three children who were simultaneously undergoing lower extremity amputations. Their ages at time of transfer ranged from 4 to 10 years and the types of lower extremity amputation included toe amputation, foot amputation and through-knee amputation. The resulting toe-to-hand transfers included three great toe-to-thumb transfers and one combined great and second toe-to-hand transfer. The toe-to-hand transfers were all successful and all the lower extremity amputations healed without complications. In all cases, improved hand function and lower extremity function was noted by the families. These unique cases represent the ultimate use of spare parts in congenital hand surgery.
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Moysidis, Nowack, Eickmeyer, Waldhausen, Brunken, Hochlenert, Engels, Santosa, Luther, and Kröger. "Trends in amputations in people with hospital admissions for peripheral arterial disease in Germany." Vasa 40, no. 4 (July 1, 2011): 289–95. http://dx.doi.org/10.1024/0301-1526/a000117.
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Background: Using the information of the federal statistics, a detailed description of the hospitalisation rate for amputation in Germany was possible for the first time, and trends since 2005 can be reported. Patients and methods: Detailed lists of all amputations coded as minor amputations (OPS 5 - 864) and major amputations (OPS 5 - 865) performed in 2005 and 2008, divided into the 4th and 5th number of the OPS-code, were provided by the Federal Statistical Office. Results: Despite an increase in total number of hospitalized patients suffering from peripheral arterial disease and neurovascular disease there is a relevant decrease in age adjusted major amputation rates per 100.000 population in Germany from 27.0 in 2005 to 25.1 in 2008 in males and from 19.7 in 2005 to 17.1 in 2008 in females. Overall minor amputation rates do not show such a decrease but increased in males (from 47.4 in 2005 to 53.7 in 2008) und remained unchanged in females (23.1 in 2005 and 23.1 in 2008). In the 6th and 7th decade of life males have approximately four times higher major and minor amputation rates than females. Conclusions: Hospitalisation rate for major amputation in Germany decreased in the recent years whereas hospitalisation rate for minor amputation did not.
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Noori, Naudereh B., Lee Haruno, Ian Schroeder, Mark Vrahas, Milton T. Little, and Carol Lin. "Do Pre-Operative Transcutaneous Oxygen Perfusion Measurements Predict Atraumatic Major Lower Extremity Amputation Wound Healing?" Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0036. http://dx.doi.org/10.1177/2473011420s00369.
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Category: Other Introduction/Purpose: Determining appropriate amputation level is a challenging task requiring clinical, laboratory, and imaging data. However, there is no validated consensus on the method with the most prognostic accuracy. Transcutaneous oxygen perfusion measurement (TcPO2) is a noninvasive means of measuring tissue oxygenation. A TcPO2 > 30-40mm Hg is widely cited as a positive predictor of post-operative wound healing, but its validity has not been well defined. We hypothesized that TcPO2 levels positively correlate with the success of amputation wound healing. Additionally, we secondarily investigated the correlation between other preoperative demographics and clinical variables and their impact on post-operative amputation wound healing. Methods: A retrospective chart review was performed on patients who underwent lower extremity above, through, or below knee amputations at a single institution with documented preoperative TcPO2 values between January 1, 2012 and December 1, 2018 and a minimum 30 days post-operative clinical follow up. Amputations performed for oncologic pathology, infected arthroplasty, osteomyelitis and traumatic amputations were excluded in order to isolate TcPO2 as a decision-making test for amputation level. This yielded one hundred and forty-one total amputations. Of these ninety-three were below knee amputations (BKA), six through knee amputations, and forty-two above knee amputations (AKA). Chi-square and t-tests were used to compare successful and failed amputations where appropriate. Results: Eighty-six of the amputations were successful and fifty-five failed, as defined by post-operative wound dehiscence or infection. Of these, thirty-seven were BKAs, four were through knee amputations and fourteen were AKAs. There was a significant difference in preoperative TcPO2 levels between the successful and failure groups at 46.2 and 38.3 respectively (p = 0.02). A TcPO2 of 30-40mm Hg had a success rate of 68.8%, and a TcPO2 < 20mm Hg a success rate of 18.2%. A receiver operating characteristic curve for TcPO2 levels predicting amputation success elucidated that with an area under the curve of 0.53 for the AKA cohort and 0.61 for the BKA cohort, the diagnostic ability is far from prognostic. Conclusion: Our results provide new insight into the predictive accuracy of preoperative TcPO2 levels. There is not a linear association between TcPO2 and success rate. A TcPO2 < 20mm Hg has a high positive predictive value for failure, but higher TcPO2 levels are not 100% predictive of amputation wound healing as reported by prior studies. Multiple factors should be considered when selecting amputation level.
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Brodell, James D., Judith F. Baumhauer, Benefict F. DiGiovanni, A. Samuel Flemister, John P. Ketz, and Irvin Oh. "Should Chopart Amputation be Performed in Diabetic Foot Ulcer Patients?" Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0011. http://dx.doi.org/10.1177/2473011419s00118.
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Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: Diabetic foot ulcers (DFU) with deep infections and osteomyelitis often lead to partial or complete limb loss. Determination of the appropriate level for amputation is challenging, and is a complex decision based on the patient’s function at baseline, extent of infection, vascular patency and comorbidities. Although Chopart amputation preserves greater limb length than Syme amputation, additional procedures, such as Achilles tenectomy and tendon transfers are necessary to optimize residual foot function. Challenges with wound healing and prosthesis fitting have been reported. We aimed to investigate the functional and clinical outcomes including patient reported outcomes of Chopart and Syme amputations. Methods: A query utilizing current procedural terminology (CPT) codes was performed to identify patients who had undergone Syme or Chopart amputations for diabetic foot infections by an academic orthopaedic group between August 2013 and September 2018. Twenty-two patients with average age of 59.8 (range, 28-79) years, comprising 18 Chopart amputations and 4 Syme amputations were identified. Demographic characteristics, body mass index, hemoglobin A1c, medical comorbidities, major and minor post-operative complications, unplanned admission or return to OR, revision surgeries, and time to receiving a brace or prosthesis information were compiled. After informed consent was obtained, subjects completed three Patient-Reported Outcomes Measurement Information Systems (PROMIS) instruments (Pain Interference (PI), Physical Function (PF), and Depression), and the SF-36. Unpaired student t-tests and Fisher’s exact test were utilized to compare patient cohorts. Statistical analysis was performed using Stata®. Results: The majority (17/18) of Chopart and half (2/4) of Syme patients developed complications including wound dehiscence and recurrent/persistent infection. Readmission and unexpected return to the OR for irrigation and debridement or revision occurred in 11/18 (61%) of Chopart and 2/4 (50%) of Syme patients. Revision amputations occurred in 10/18 (56%) Chopart patients (2 Syme, 8 BKA), and 1/4 (25%) Syme patients (BKA). Half of Chopart patients never received a prosthesis due to delayed wound healing and revision amputation. All Syme amputation patients received a prosthesis and resumed ambulation. The average time to prosthesis was 4.5 and 6.5 months for Syme and Chopart patients, respectively. There was no significant difference between Syme and Chopart patients in all PROMIS domains, or the SF-36 (p-values > 0.05) (Table 1). Conclusion: We found a high rate of complications and revision procedures in Chopart amputation patients. In our patient cohort, there was a high likelihood that a patient who underwent a Chopart amputation ultimately received a below knee amputation. Even after wound healing, patients with Chopart amputations may struggle with obtaining a prosthesis suitable for ambulation. Syme amputation patients were less likely to require revision amputation, and received a prosthesis more rapidly relative to Chopart amputation patients. The complication and revision rates of Chopart amputations indicate that surgeons should exercise judicious patient selection prior to performing these procedures.
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Greitemann. "Extremitätenerhaltende Amputations- und Resektionstechniken am Fuß." Vasa 38, Supplement 74 (February 1, 2009): 37–53. http://dx.doi.org/10.1024/0301-1526.38.s74.37.
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Die wesentlichen ätiologischen Enthitäten für Amputationen an der unteren Extremität sind der Diabetes mellitus und die Durchblutungsstörungen. Gerade bei diesen Ursachen kommt es durch die begleitende Multimorbidität des Patienten häufig zu erheblichen Rehabilitationsbehinderungen und Invalidisierungen mit hohen Teilhabestörungen durch hohe Amputationen. Extremitäten erhaltende Amputations- und Resektionstechniken im Fußbereich sind speziell beim Diabetes mellitus daher von besonderer Bedeutung, da der Patient ein hohes Risiko hat, auch auf der Gegenseite eine Amputation zu erleiden. Profunde Kenntnisse in den Amputationstechniken am Fuß und der anschließenden orthopädieschuhtechnischen oder prothetischen Versorgung ermöglichen gute Behandlungsergebnisse.
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Ólafsdóttir, Arndís Finna, Ann-Marie Svensson, Aldina Pivodic, Soffia Gudbjörnsdottir, Thomas Nyström, Hans Wedel, Annika Rosengren, and Marcus Lind. "Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes." BMJ Open Diabetes Research & Care 7, no. 1 (April 2019): e000602. http://dx.doi.org/10.1136/bmjdrc-2018-000602.
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ObjectiveThis study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1 diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.Research design and methodsWe analyzed data from people with type 1 DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36 872) was randomly matched with five controls by sex, age, and county (n=184 360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.ResultsThe overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1 DM versus controls. HR increased with longer diabetes duration. The incidence of amputation/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1 DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998–2001 (3.09, 95% CI 2.56 to 3.62) to 2011–2013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10 mmol/mol (1%) increase in hemoglobin A1c.ConclusionsAlthough the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.
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Chung, Pui M., Bolton KH Chau, Esther C.-S. Chow, Kwok H. Lam, and Nang MR Wong. "Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population." Journal of Orthopaedics, Trauma and Rehabilitation 28 (January 2021): 221049172110569. http://dx.doi.org/10.1177/22104917211056949.
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Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.
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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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JAYARAM, Mayank, Chang WANG, Alfred P. YOON, Lu WANG, and Kevin C. CHUNG. "Using Rasch Analysis to Evaluate the Psychometric Properties of the Brief MHQ in Patients with Traumatic Finger Amputations." Journal of Hand Surgery (Asian-Pacific Volume) 28, no. 02 (April 2023): 225–34. http://dx.doi.org/10.1142/s2424835523500248.
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Background: Digit amputations affect 45,000 Americans each year and are associated with substantial healthcare expenditures and loss of wages. Few patient-reported outcome measures (PROMs) are validated in patients with digit amputations. The brief Michigan Hand Outcomes Questionnaire (bMHQ) is a 12-item PROM used in several hand conditions. However, its psychometric properties have not been investigated in patients with digit amputations. Methods: The reliability and validity of the bMHQ was investigated using Rasch analysis. Data were collected from the Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE) study. Participants were divided into replantation and revision amputation cohorts and then further separated into single-digit amputation (excluding thumb), thumb-only amputation and multiple-digit amputation (excluding thumb) subgroups. Each of the six subgroups were analysed for item fit, threshold ordering, targeting, differential item functioning (DIF), unidimensionality and internal consistency. Results: All treatment groups demonstrated high unidimensionality (Martin-Löf test = 1) and internal consistency (Cronbach's α > 0.85). The bMHQ is not a reliable PROM in individuals with single-digit or multiple-digit amputations. The aesthetics, satisfaction and two-handed activities of daily living (ADLs) items had the poorest fit to the Rasch model across all categories. Conclusions: The bMHQ is not well-suited for measuring outcomes in patients with digit amputations. We recommend clinicians use more comprehensive assessment tools, such as the complete MHQ, to measure outcomes in these complex patient populations. Level of Evidence: Level III (Diagnostic)
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Lamoreaux, B., M. Francis-Sedlak, and R. Holt. "OP0169 AMPUTATION PROCEDURES IN PATIENTS WITH GOUT COMPARED TO PATIENTS WITH DIABETES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 106.2–107. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2058.
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Background:Gout is the most common inflammatory arthritis in the United States (U.S.) and is associated with specific comorbidities, including hypertension, renal disease, cardiovascular disease, hyperlipidemia, and metabolic syndrome (1). This set of comorbidities is known for carrying an increased risk of macrovascular complications (e.g., myocardial infarction, stroke) and peripheral limb problems (e.g., skin ulcers, amputations). Diabetics are known to have an elevated risk of undergoing ulcer and amputation procedures, which have been shown to increase morbidity and mortality in this population (2,3). It is currently not known if patients with gout have an elevated independent risk for limb amputations or whether gout potentiates amputation rates in patients with diabetes.Objectives:To assess and compare the rate of amputation procedures conducted in patients with gout, diabetes, both gout and diabetes, and neither gout nor diabetes.Methods:In September 2019, a large U.S. claims database (includes data from 190 million patients over 7 years, TriNetX “Diamond” network) was used to determine amputation rates in patients with gout and diabetes. TriNetX only provides aggregate data and statistical summaries of de-identified patient information. Initial cohorts were developed to understand the amputation rate in patients with gout, regardless of diabetes comorbidity (n=4,467,721), and the amputation rate in patients with diabetes, regardless of gout comorbidity (n= 25,972,726). Subsequently, the following four cohorts were constructed to isolate these two diseases: 1) presence of gout without diabetes (n=2,471,430), 2) presence of diabetes without gout (n=23,976,435), 3) presence of both gout and diabetes (n=1,996,291), and 4) absence of both gout and diabetes (control cohort, n=144,705,645). Demographic features of these groups were tabulated and amputation (foot, toes, hand, fingers) rates were calculated using procedural codes reported in each group.Results:The overall rate of amputations in patients with gout (0.434%) was similar to the amputation rate in patients with diabetes (0.484%). However, when separating these patients into distinct, non-overlapping cohorts, the amputation rate in patients with gout but not diabetes (0.162%) differed from the rate in patients with diabetes but not gout (0.461%). The control population (no gout or diabetes) had an amputation rate of 0.035%. Unexpectedly, patients with both gout and diabetes had an amputation rate of 0.770%, the highest of all groups examined.Conclusion:Gout is increasingly being linked to unfavorable cardiovascular, renal, and metabolic complications. Our analysis showed that having gout also increased the likelihood of undergoing an amputation procedure. Patients with gout but not diabetes suffered an approximately 3-fold increase in amputations compared to patients without either disease. Additionally, patients with both gout and diabetes had a notably increased risk of amputation compared to patients with only diabetes (no gout). Because amputations are an unfavorable outcome associated with procedural complication risk and long-term sequelae, this apparent increased risk of amputation in patients with gout warrants further exploration.References:[1]Dalbeth N, et al.Nature Reviews Disease Primers, 2019;5(69):1-17[2]Geiss LS, et al.Diabetes Care, 2019;42:50-54[3]Moulik PK, et al.Diabetes Care, 2003;26:491-494Disclosure of Interests:Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Robert Holt Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics