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The International Journal of Lower... Jun 2019The excess risk of amputation in the diabetic population is well documented. However, approximately half of all amputations in England are in people that do not have... (Comparative Study)
Comparative Study Review
The excess risk of amputation in the diabetic population is well documented. However, approximately half of all amputations in England are in people that do not have diabetes - the remainder being mainly peripheral arterial disease. Whilst the prevalence of foot ulcers in the population without diabetes is significantly lower than their diabetic counterparts, the actual number of people with ulcers, and, therefore, the burden on services, is, the same. In addition to this inequality, the prevalence of amputation is greater in men than women and in the North of England compared with the South. We suggest that whilst diabetes is an important inequality to continue addressing, it is not the only one.
Topics: Adult; Age Factors; Amputation, Surgical; Diabetic Foot; England; Female; Health Status Disparities; Healthcare Disparities; Humans; Lower Extremity; Male; Middle Aged; Peripheral Arterial Disease; Prevalence; Risk Assessment; Sex Factors
PubMed: 30919710
DOI: 10.1177/1534734619834749 -
BMC Veterinary Research Jan 2016The amputation of a limb is a surgical procedure that is regularly performed in small animal practice. In spite of several clinical reports indicating high owner...
BACKGROUND
The amputation of a limb is a surgical procedure that is regularly performed in small animal practice. In spite of several clinical reports indicating high owner satisfaction after limb amputation in dogs, an amputation is still very critically seen by the owners, and even by some veterinarians, due to the lack of accurate information about the recovery of amputee patients. Thus, the objective of this study was to prospectively evaluate, both objectively and subjectively, the recovery outcome of dogs undergoing a hind limb amputation. Twelve patients in which a hind limb amputation was scheduled were studied. Kinetic and kinematic gait analyses were performed before the amputation, and 10, 30, 90 and 120 days after surgery. Magnetic resonance (MR) examination of the contralateral stifle joint was performed before and 120 days after amputation. The subjective impressions of the owners were gathered at the same examination times of the gait analyses.
RESULTS
Kinetic data showed a redistribution of the load to all remaining limbs after the amputation; ten days after the procedure patients had already established their new locomotory pattern. Kinematic data showed significant differences between sessions in the mean angle progression curves of almost all analyzed joints; however, the ranges of motion were very similar before and after the amputation, and remained constant in the subsequent sessions after the amputation. No changes in the signal intensity of the soft tissues evaluated, and no evidence of cartilage damage or osteoarthritis was seen on the MR examination of the contralateral stifle. Owners evaluated the results of the amputation very positively, both during and at the end of the study.
CONCLUSIONS
Dogs had a quick adaptation after a hind limb amputation, and the adaptation process began before the amputation was performed. This happened without evidence of morphologic changes in the contralateral stifle joint, and with a very positive evaluation from the owner.
Topics: Adaptation, Physiological; Amputation, Surgical; Animals; Biomechanical Phenomena; Dogs; Female; Gait; Hindlimb; Kinetics; Magnetic Resonance Spectroscopy; Male; Outcome Assessment, Health Care; Patient Satisfaction; Prospective Studies; Self Report
PubMed: 26810893
DOI: 10.1186/s12917-016-0644-5 -
BMC Surgery Oct 2014Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly... (Review)
Review
BACKGROUND
Diabetic foot infections are a frequent clinical problem. About 50% of patients with diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches.
DISCUSSION
The article debates the pros and cons of amputation of the diabetic foot. The thesis is that if the guidelines on the management of the diabetic foot are followed primary amputation is only necessary for the unsalvageable diabetic foot. This approach would reduce the incidence of lower limb amputations in diabetic patients.
SUMMARY
We favour the argument that a structured clinical and vascular assessment would help clinical decision- making as to which patients to hospitalize, which to send for imaging, or for whom to recommend surgical interventions. Endovascular procedures are the future in the treatment of diabetic arterial disease and hence the diabetic foot.
Topics: Amputation, Surgical; Decision Making; Diabetic Foot; Endovascular Procedures; Humans
PubMed: 25344293
DOI: 10.1186/1471-2482-14-83 -
Journal of the Chinese Medical... Oct 2015Publications on digital amputation and replantation have been mostly derived from case series in high-volume hand surgery practices, and epidemiological studies are few....
BACKGROUND
Publications on digital amputation and replantation have been mostly derived from case series in high-volume hand surgery practices, and epidemiological studies are few. This study used a population-based dataset to illustrate the incidence of digital amputation, patient and hospital characteristics, and their relationships with replantation.
METHODS
A claim for reimbursement dataset (2008) was provided as a research database by the Bureau of National Health Insurance, Taiwan. Patients with ICD-9-CM coded as digital amputation (885 and 886) were included. These were cross-referenced with procedure codes for replantation procedures (84.21 and 84.22). We defined the patients who underwent thumb replantation (84.21) and thumb amputation (84.01) during a single hospitalization as replantation failure. Patient and hospital characteristics were studied with statistical analysis.
RESULTS
In total, 2358 patients with digital amputation were admitted (1859 male, 499 female), mean age 39.2 ± 15.5 years. The incidence was 10.2/100,000 person-years. The highest incidence was 14.7/100,000 person-years in the age group 45-54 years. Machinery and powered hand tools caused 68.8% of digital amputations. Thumb amputation [odds ratio (OR): 1.35, p = 0.01], private hospital (OR: 1.40, p = 0.01), medical center (OR: 2.38, p < 0.001), regional hospital (OR: 2.41, p < 0.001) and hospitals with an annual volume >20 digital amputations (OR: 4.23, p < 0.001) were associated with higher attempt rates for replantation. Elderly patients (age >65 years) had higher risk of thumb replantation failure (OR: 32.30, p = 0.045), while hospitals with >20 annual replantations had lower risk (OR: 0.11, p = 0.02).
CONCLUSION
Our study of the National Health Insurance database characterized the epidemiology of digital amputation patients undergoing replantation and the facilities in Taiwan where these procedures are performed. The hospitals treating more digital amputation patients had higher attempt rates and lower thumb failure rates.
Topics: Adult; Aged; Amputation, Surgical; Female; Humans; Male; Middle Aged; Replantation; Taiwan; Thumb; Treatment Failure
PubMed: 25908553
DOI: 10.1016/j.jcma.2015.03.005 -
International Orthopaedics Oct 2012Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian... (Review)
Review
Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.
Topics: Amputation, Surgical; Disasters; Humans; Mass Casualty Incidents; Postoperative Complications; Surgical Wound Infection; Traumatology
PubMed: 22714553
DOI: 10.1007/s00264-012-1573-y -
Journal of Musculoskeletal & Neuronal... Jun 2022Structural musculoskeletal adaptations following amputation, such as bone mineral density (BMD) or muscle architecture, are often overlooked despite their established... (Review)
Review
Structural musculoskeletal adaptations following amputation, such as bone mineral density (BMD) or muscle architecture, are often overlooked despite their established contributions to gait rehabilitation and the development of adverse secondary physical conditions. The purpose of this review is to provide a summary of the existing literature investigating musculoskeletal adaptations in individuals with major lower-limb amputations to inform clinical practice and provide directions for future research. Google Scholar, PubMed, and Scopus were searched for original peer-reviewed studies that included individuals with transtibial or transfemoral amputations. Summary data of twenty-seven articles indicated reduced BMD and increased muscle atrophy in amputees compared to controls, and in the amputated limb compared to intact and control limbs. Specifically, BMD was reduced in T-scores and Z-scores, femoral neck, and proximal tibia. Muscle atrophy was evidenced by decreased thigh cross-sectional area, decreased quadriceps thickness, and increased amounts of thigh fat. Overall, amputees have impaired musculoskeletal health. Future studies should include dysvascular etiologies to address their effects on musculoskeletal health and functional mobility. Moreover, clinicians can use these findings to screen increased risks of adverse sequelae such as fractures, osteopenia/porosis, and muscular atrophy, as well as target specific rehabilitation exercises to reduce these risks.
Topics: Amputation, Surgical; Amputees; Humans; Lower Extremity; Muscular Atrophy; Tibia
PubMed: 35642706
DOI: No ID Found -
Scientific Reports Oct 2013Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and... (Comparative Study)
Comparative Study
Little is known about whether and how multimodal representations of the body (BRs) and of the space around the body (Peripersonal Space, PPS) adapt to amputation and prosthesis implantation. In order to investigate this issue, we tested BR in a group of upper limb amputees by means of a tactile distance perception task and PPS by means of an audio-tactile interaction task. Subjects performed the tasks with stimulation either on the healthy limb or the stump of the amputated limb, while wearing or not wearing their prosthesis. When patients performed the tasks on the amputated limb, without the prosthesis, the perception of arm length shrank, with a concurrent shift of PPS boundaries towards the stump. Conversely, wearing the prosthesis increased the perceived length of the stump and extended the PPS boundaries so as to include the prosthetic hand, such that the prosthesis partially replaced the missing limb.
Topics: Adult; Aged; Amputation, Surgical; Arm; Artificial Limbs; Case-Control Studies; Female; Hand; Humans; Male; Middle Aged; Personal Space; Physical Stimulation; Prosthesis Implantation; Space Perception; Touch Perception; Young Adult
PubMed: 24088746
DOI: 10.1038/srep02844 -
Ethiopian Journal of Health Sciences Jan 2018Amputation is a surgical procedure for the removal of a limb which is indicated when limb recovery is impossible. There are different types of amputation, and their...
BACKGROUND
Amputation is a surgical procedure for the removal of a limb which is indicated when limb recovery is impossible. There are different types of amputation, and their causes can vary from one area to the other. Therefor, the aim of this study is to find out the patterns and causes of amputations in patients presented to Ayder Referral Hospital, Mekelle, Ethiopia.
METHODS
the record of 87 patients who had amputation at different sites after admission to Ayder referral hospital, Mekelle, Ethiopia in three years period were reviewed retrospectively.
RESULT
A total of 87 patients had amputation of which 78.2% were males. The age range was from 3 to 95 years, and the mean age was 40.6 in years. The most common indications were trauma (37.7%), tumor (24.1%), and peripheral arterial disease (PAD) (20.7%). The commonest type of amputation was major lower limb amputation (58.6%) which includes above knee amputation (35.6%)and below knee amputation (23%) followed by digital amputation (17.2%). There was 11.4% major upper limb amputation of which there was one patient who had re-amputation.
CONCLUSION
Most of the indications for amputations in our setup are potentially preventable by increasing awareness in the society on safety measures both at home and at work and early presentation to health facilities.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amputation, Surgical; Child; Child, Preschool; Ethiopia; Female; Humans; Lower Extremity; Male; Middle Aged; Neoplasms; Peripheral Arterial Disease; Referral and Consultation; Retrospective Studies; Wounds and Injuries; Young Adult
PubMed: 29622905
DOI: 10.4314/ejhs.v28i1.5 -
European Journal of Vascular and... Feb 2016Lower limb amputation is often associated with a high risk of early post-operative mortality. Mortality rates are also increasingly being put forward as a possible... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Lower limb amputation is often associated with a high risk of early post-operative mortality. Mortality rates are also increasingly being put forward as a possible benchmark for surgical performance. The primary aim of this systematic review is to investigate early post-operative mortality following a major lower limb amputation in population/regional based studies, and reported factors that might influence these mortality outcomes.
METHODS
Embase, PubMed, Cinahl and Psycinfo were searched for publications in any language on 30 day or in hospital mortality after major lower limb amputation in population/regional based studies. PRISMA guidelines were followed. A self developed checklist was used to assess quality and susceptibility to bias. Summary data were extracted for the percentage of the population who died; pooling of quantitative results was not possible because of methodological differences between studies.
RESULTS
Of the 9,082 publications identified, results were included from 21. The percentage of the population undergoing amputation who died within 30 days ranged from 7% to 22%, the in hospital equivalent was 4-20%. Transfemoral amputation and older age were found to have a higher proportion of early post-operative mortality, compared with transtibial and younger age, respectively. Other patient factors or surgical treatment choices related to increased early post-operative mortality varied between studies.
CONCLUSIONS
Early post-operative mortality rates vary from 4% to 22%. There are very limited data presented for patient related factors (age, comorbidities) that influence mortality. Even less is known about factors related to surgical treatment choices, being limited to amputation level. More information is needed to allow comparison across studies or for any benchmarking of acceptable mortality rates. Agreement is needed on key factors to be reported.
Topics: Age Factors; Amputation, Surgical; Comorbidity; Hospital Mortality; Humans; Lower Extremity; Odds Ratio; Postoperative Complications; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26588994
DOI: 10.1016/j.ejvs.2015.10.001 -
International Orthopaedics Apr 2013
Review
Topics: Amputation, Surgical; France; History, 16th Century; Ligation
PubMed: 23474839
DOI: 10.1007/s00264-013-1857-x