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Physical Medicine and Rehabilitation... Feb 2014In 2005, 1.6 million people were estimated to be living with limb loss; by 2050, the rate is expected to double to 3.6 million in the United States. Past data have shown... (Review)
Review
In 2005, 1.6 million people were estimated to be living with limb loss; by 2050, the rate is expected to double to 3.6 million in the United States. Past data have shown that the rates of dysvascular amputations were increasing. However, recent studies looking at single diseases of peripheral arterial disease and diabetes mellitus show amputations related to these conditions are now decreasing. The authors think that it may not be a single disease process but rather the cumulative illness burden that is leading to amputations. In addition to cause, age, gender, and race continue to play a role in limb loss.
Topics: Amputation, Surgical; Congenital Abnormalities; Diabetes Complications; Ethnicity; Humans; Neoplasms; Peripheral Arterial Disease; Reoperation; Sex Factors; United States; Wounds and Injuries
PubMed: 24287235
DOI: 10.1016/j.pmr.2013.09.001 -
Tidsskrift For Den Norske Laegeforening... May 2017BACKGROUND We wished to study the therapy for lower limb amputees at Sørlandet Hospital Kristiansand after restructuring of activities in 2004.MATERIAL AND METHOD All...
BACKGROUND We wished to study the therapy for lower limb amputees at Sørlandet Hospital Kristiansand after restructuring of activities in 2004.MATERIAL AND METHOD All lower limb amputees hospitalised in the Department of Physical Medicine and Rehabilitation between March 2012 and July 2015 were followed up prospectively.RESULTS A total of 50 patients with 54 amputations were followed up for at least three months. Altogether 31 transtibial amputations, 22 transfemoral amputations and one knee disarticulation were performed. The median age of the patients was 66 years, 36 of whom were men, median Charlson comorbidity index was 1.5, 14 smoked, 8 were substance abusers, 9 were able to walk at least 2 km preoperatively, 44 of the amputations were performed with myodesis, and 41 patients were transferred directly to the Department of Physical Medicine and Rehabilitation. At the three-month check-up, 48 patients used their custom-made prostheses, average walk-test time was 21 seconds, and 45 lived in their own home. At the one-year check-up, 32 of 35 patients who attended used prostheses, and average walk-test time was 18 seconds. Use of painkillers declined during the period. Advanced age, transfemoral amputation and substance abuse were associated with longer walk-test time at the three-month check-up.INTERPRETATION Most patients achieved a good level of function, and the therapy appears to be functioning satisfactorily.
Topics: Adult; Aged; Aged, 80 and over; Amputation, Surgical; Analgesics; Artificial Limbs; Cohort Studies; Critical Pathways; Disarticulation; Female; Femur; Humans; Knee Joint; Male; Middle Aged; Norway; Patient Care Team; Physical Therapy Modalities; Prospective Studies; Recovery of Function; Surveys and Questionnaires; Tibia; Treatment Outcome; Young Adult
PubMed: 28468477
DOI: 10.4045/tidsskr.16.0390 -
Polski Przeglad Chirurgiczny Apr 2017The amputation of the lower limb is a crippling procedure, which impairs both physical and mental aspect of the patient's life and therefore, it is important to provide... (Review)
Review
The amputation of the lower limb is a crippling procedure, which impairs both physical and mental aspect of the patient's life and therefore, it is important to provide these patients with comprehensive health care. Patients and their families must change their lives and reorganize them, which is undoubtedly associated with a decrease in the quality of life. The aim of this study was to analyze various determinants of quality of life in patients after lower limb amputation and their impact on the physical, mental and social aspect of life. Based on the available literature, this paper discusses certain factors determining quality of life, including the presence of phantom pain and stump pain, the way patients move, independence in daily activity, occupational activity, and access to rehabilitation. Analysis of the impact of particular factors on quality of life in people after lower limb amputation may contribute to the improvement and introduction of new paradigms regarding care provided for amputees.
Topics: Activities of Daily Living; Adaptation, Psychological; Amputation, Surgical; Amputees; Health Status Indicators; Humans; Mental Health; Quality of Life; Social Support; Sociological Factors
PubMed: 28537564
DOI: 10.5604/01.3001.0009.8980 -
Journal of Foot and Ankle Research Mar 2020In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data...
BACKGROUND
In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes-associated lower extremity amputation.
METHODS
We collected data reporting 5-year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute.
RESULTS
Five year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%. Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one-third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable.
CONCLUSION
Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer-free, hospital-free and activity-rich days.
Topics: Amputation, Surgical; Arthropathy, Neurogenic; Diabetic Foot; Health Care Costs; Humans; Lower Extremity; Neoplasms
PubMed: 32209136
DOI: 10.1186/s13047-020-00383-2 -
Agri : Agri (Algoloji) Dernegi'nin... Jul 2016In the last two decades, mirror therapy has become a frequently used method of managing phantom limb pain (PLP). However, the role of nurses in mirror therapy has not... (Clinical Trial)
Clinical Trial
OBJECTIVES
In the last two decades, mirror therapy has become a frequently used method of managing phantom limb pain (PLP). However, the role of nurses in mirror therapy has not yet been well defined. This study examined the effect of mirror therapy on the management of PLP, and discusses the importance of mirror therapy in the nursing care of amputee patients.
METHODS
This quasi-experimental study was conducted in the pain management department of a university hospital and a prosthesis clinic in İstanbul, Turkey, with 15 amputee patients who had PLP. Forty minutes of practical mirror therapy training was given to the patients and they were asked to practice at home for 4 weeks. Patients were asked to record the severity of their PLP before and after the therapy each day using 0-10 Numeric Pain Intensity Scale.
RESULTS
Mirror therapy practiced for 4 weeks provided a significant decrease in severity of PLP. There was no significant relationship between the effect of mirror therapy and demographic, amputation or PLP-related characteristics. Patients who were not using prosthesis had greater benefit from mirror therapy.
CONCLUSION
Mirror therapy can be used as an adjunct to medical and surgical treatment of PLP. It is a method that patients can practice independently, enhancing self-control over phantom pain. As mirror therapy is a safe, economical, and easy-to-use treatment method, it should be considered in the nursing care plan for patients with PLP.
Topics: Amputation, Surgical; Female; Humans; Lower Extremity; Male; Middle Aged; Nurse's Role; Pain Measurement; Phantom Limb; Physical Therapy Modalities; Severity of Illness Index; Treatment Outcome; Upper Extremity
PubMed: 27813030
DOI: 10.5505/agri.2016.48343 -
Clinical Orthopaedics and Related... Oct 2014Limb amputation has been carried out through the ages as a punitive method in various parts of the world. This article highlights the historical and societal background... (Review)
Review
BACKGROUND
Limb amputation has been carried out through the ages as a punitive method in various parts of the world. This article highlights the historical and societal background associated with the use of punitive limb amputation.
METHODS
We performed an extensive electronic search of the pertinent literature augmented with a hand-search of additional sources.
RESULTS
Evidence for punitive amputation is available as early as the court of the Babylonian Code of King Hammurabi (circa 1750 Before the Common Era [BCE]), which imposed punitive limb amputations on slaves who used force against free citizens. Other reports provided evidence that punitive amputation was used as early as the 4th century BCE in ancient Peru. Limb amputation restored law and order during the Roman and Byzantine periods. Amputation as a punitive instrument prevailed in Europe throughout the 17th century. During the Enlightenment, the intellectual movement in Europe approached criminal law from a humanistic perspective, incorporated it into societal practice, and promoted its preventive dimensions. Punitive limb amputation still exists in several Arab and African countries.
CONCLUSION
Amputation as a punitive or correctional method has its roots in old civilizations. It has been used through the ages in various parts of the world. While it has been abandoned in modern western societies, punitive amputation is still used in several third-world countries.
Topics: Amputation, Surgical; Crime; Developing Countries; History, 17th Century; History, Ancient; Humans; Punishment; Sculpture; Social Control, Formal; Social Perception
PubMed: 24522383
DOI: 10.1007/s11999-014-3480-6 -
Vascular Dec 2022Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate... (Review)
Review
OBJECTIVES
Through-knee amputation is an umbrella term for several different surgical techniques, which may affect clinical and functional outcomes. This makes it hard to evaluate the benefits and need for a through-knee amputation approach. This article seeks to (1) determine the number of through-knee amputation performed compared with other major lower limb amputations in England over the past decade; (2) identify the theoretical concepts behind through-knee amputation surgical approaches and their potential effect on functional and clinical outcomes and (3) provide a platform for discussion and research on through-knee amputation and surgical outcomes.
METHODS
National Health Service Hospital Episodes Statistics were used to obtain recent numbers of major lower limb amputations in England. EMBASE and MEDLINE were searched using a systematic approach with predefined criteria for relevant literature on through-knee amputation surgery.
RESULTS
In the past decade, 4.6% of major lower limb amputations in England were through-knee amputations. Twenty-six articles presenting through-knee amputation surgical techniques met our criteria. These articles detailed three through-knee amputation surgical techniques: the classical approach, which keeps the femur intact and retains the patella; the Mazet technique, which shaves the femoral condyles into a box shape and the Gritti-Stokes technique, which divides the femur proximal to the level of the condyles and attaches the patella at the distal cut femur.
CONCLUSIONS
Through-knee amputation has persisted as a surgical approach over the past decade, with three core approaches identified. Studies reporting clinical, functional and biomechanical outcomes of through-knee amputation frequently fail to distinguish between the three distinct and differing approaches, making direct comparisons difficult. Future studies that compare through-knee amputation approaches to one another and to other amputation levels are needed.
Topics: Humans; State Medicine; Disarticulation; Amputation, Surgical; Lower Extremity; England
PubMed: 34844469
DOI: 10.1177/17085381211045183 -
PloS One 2020Phantom limb pain (PLP)-pain felt in the amputated limb-is often accompanied by significant suffering. Estimates of the burden of PLP have provided conflicting data. To... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Phantom limb pain (PLP)-pain felt in the amputated limb-is often accompanied by significant suffering. Estimates of the burden of PLP have provided conflicting data. To obtain a robust estimate of the burden of PLP, we gathered and critically appraised the literature on the prevalence and risk factors associated with PLP in people with limb amputations.
METHODS
Articles published between 1980 and July 2019 were identified through a systematic search of the following electronic databases: MEDLINE/PubMed, PsycINFO, PsycArticles, Cumulative Index to Nursing and Allied Health Literature, Africa-Wide Information, Health Source: Nursing/Academic Edition, SCOPUS, Web of Science and Academic Search Premier. Grey literature was searched on databases for preprints. Two reviewers independently conducted the screening of articles, data extraction and risk of bias assessment. The meta-analyses were conducted using the random effects model. A statistically significant level for the analyses was set at p<0.05.
RESULTS
The pooling of all studies demonstrated a prevalence estimate of 64% [95% CI: 60.01-68.05] with high heterogeneity [I2 = 95.95% (95% CI: 95.10-96.60)]. The prevalence of PLP was significantly lower in developing countries compared to developed countries [53.98% vs 66.55%; p = 0.03]. Persistent pre-operative pain, proximal site of amputation, stump pain, lower limb amputation and phantom sensations were identified as risk factors for PLP.
CONCLUSION
This systematic review and meta-analysis estimates that six of every 10 people with an amputation report PLP-a high and important prevalence of PLP. Healthcare professionals ought to be aware of the high rates of PLP and implement strategies to reduce PLP by addressing known risk factors, specifically those identified by the current study.
Topics: Amputation, Surgical; Clinical Decision-Making; Humans; Phantom Limb; Prevalence; Risk Factors
PubMed: 33052924
DOI: 10.1371/journal.pone.0240431 -
Ugeskrift For Laeger Jan 2023In this case report, a 75-year-old unvaccinated female patient presented with hypoxaemia, and she was admitted to an intensive care unit. After four days her left hand...
In this case report, a 75-year-old unvaccinated female patient presented with hypoxaemia, and she was admitted to an intensive care unit. After four days her left hand was discoloured blue, and fibrin D-dimer was elevated. An angiogram showed occlusion in the arteria radialis at the level of the bifurcature. Thrombolysis had no effect, and the patient's left arm was amputated above elbow level. COVID-19 is still a present problem worldwide, and it is important to be alert and aware of the risk of serious thromboembolic complications when treating unvaccinated patients.
Topics: Humans; Female; Aged; COVID-19; Arm; Thrombosis; Thromboembolism; Amputation, Surgical
PubMed: 36760140
DOI: No ID Found -
Wounds : a Compendium of Clinical... Aug 2015
Topics: Amputation, Surgical; Attitude of Health Personnel; Diabetic Foot; Humans; Treatment Outcome
PubMed: 26284378
DOI: No ID Found