Through-knee versus above-knee amputation for vascular and non-vascular major lower limb amputations

An analysis of nine replantations of completely amputated lower limbs is presented in this paper. Four cases were successful, including two at the level of the distal third of the tibia, one through the midfoot, and one at the proximal third of the tibia. The latter case involved the replantation of the shortened limb followed by a Syme's amputation of the foot to preserve a functional below-knee amputation level. In each successful case protective sensibility, bony union, and a stable stance and functional gait has been achieved, thereby eliminating a prosthetic requirement.

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A case series featuring extremely short below-knee stumps

Prosthetics and Orthotics International ◽

10.1177/0309364611430535 ◽

2011 ◽

Vol 36 (2) ◽

pp. 236-238 ◽

Cited By ~ 7

Author(s):

Jose Andre Carvalho ◽

Mauricio Dias Mongon ◽

William Dias Belangero ◽

Bruno Livani

Keyword(s):

Lower Limb ◽

Case Series ◽

Collateral Ligaments ◽

Gait Patterns ◽

Knee Amputation ◽

Lever Arm ◽

End Of Treatment ◽

Patient Groups ◽

Functional Gait

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

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Cause of death of lower limb amputees

Prosthetics and Orthotics International ◽

10.3109/03093649209164325 ◽

1992 ◽

Vol 16 (2) ◽

pp. 129-132 ◽

Cited By ~ 13

Author(s):

C. P. U. Stewart ◽

A. S. Jain

Keyword(s):

Heart Disease ◽

General Population ◽

Cerebrovascular Disease ◽

Cause Of Death ◽

Lower Limb ◽

Causes Of Death ◽

Knee Amputation ◽

Comprehensive Database ◽

Lower Limb Amputees

A study was carried out on the cause of death of 100 lower limb amputees who had been admitted to the Dundee Limb Fitting Centre, Tayside, Scotland for prosthetic management or wheelchair training. A comprehensive database has been established in the Centre for 25 years and the database is updated regularly. The date of death was collected and recorded. One hundred sequential deaths were investigated to review the cause of their death and compare this with the recorded causes of death for the Tayside population for the year of study. Ninety three per cent had an amputation for vascular related causes, with 73% having a below-knee amputation and 17% above-knee. Heart disease was the most frequent recorded cause of death (51%) of the amputee whereas only 28.1% of the Tayside group died from this pathology (p<0.01). Carcinomatosis was reported as a cause of death in 14% of the amputees and 23.5% of the Tayside group. Cerebrovascular disease caused death in 6% of the amputees and in 12.3% of the Tayside group (both p<0.01). These findings confirm earlier suggestions that vascular amputees die from heart disease more often than the general population.

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Multiligamentary Reconstruction in a Below-Knee Amputation Patient

Case Reports in Orthopedics ◽

10.1155/2021/8854005 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

María Tuca ◽

Tomás Pineda ◽

Ignacio Valderrama ◽

Gonzalo Ferrer ◽

Sergio Maass ◽

...

Keyword(s):

Early Treatment ◽

Lower Limb ◽

Functional Results ◽

Complex Situation ◽

Severe Condition ◽

Transtibial Amputation ◽

Delay In Diagnosis ◽

Knee Amputation ◽

Ligament Instability ◽

Multiligament Injury

Multiligament injuries in below-knee amputation patients are a severe condition, and its treatment is controversial. Its incidence is unknown, and it is highly underdiagnosed, representing a challenge for the physician. The case presented is about a patient with a left transtibial amputation secondary to a severe crushing of the ipsilateral lower limb to which during the process of physiotherapy, a multiligament injury was diagnosed. The patient underwent a tibiofibular fixation with a multiligament reconstruction with good functional results. In this complex situation, delay in diagnosis is frequent, ligament instability should always be suspected and explored further, allowing for proper rehabilitation and early treatment.

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Limb Salvage Procedure in a Patient of High-tension Electric Burns Utilising Delay Phenomenon in Perforator-based Flap- A Case Report

Journal of Internal Medicine and Emergency Research ◽

10.37191/mapsci-2582-7367-2(2)-026 ◽

2021 ◽

Author(s):

Shailendra Singh

Keyword(s):

Lower Limb ◽

Burn Injury ◽

Salvage Procedure ◽

Delay Procedure ◽

Knee Amputation ◽

High Tension ◽

Bilateral Lower Limb ◽

The Right ◽

Electric Burns ◽

Delay Phenomenon

Electric burn is a devastating injury causing tissue and organ loss. We present here a case of an electric burn injury over a bilateral lower limb and bilateral upper limb. The patient had undergone left above-knee amputation, thus cross-leg flap from the left side was not possible and due to electric burns, the vascularity of the right leg was also doubtful therefore a delayed flap was planned to cover the exposed defect over the right knee and defect over the right tibia. The Flaps underwent a delay procedure before the final inset so that the flap undergo ischemic preconditioning and the neovascularization that increases the size of the flap and chances of survival of the flap by manifold.

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Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽

10.1177/02676591211050608 ◽

2021 ◽

pp. 026765912110506

Author(s):

Natasha Habr ◽

Jamal J Hoballah ◽

Jamil Borgi ◽

Caroline Hamadi ◽

Pierre Sfeir ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Major Amputation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Venous Cannulation ◽

Knee Amputation ◽

Venous Cannula ◽

Arterial Insufficiency ◽

Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

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A review of through-knee amputation

Vascular ◽

10.1177/17085381211045183 ◽

2021 ◽

pp. 170853812110451

Author(s):

Brieuc Panhelleux ◽

Joseph Shalhoub ◽

Anne K Silverman ◽

Alison H McGregor

Keyword(s):

Lower Limb ◽

Relevant Literature ◽

Surgical Techniques ◽

Potential Effect ◽

Surgical Approaches ◽

Theoretical Concepts ◽

Future Studies ◽

Knee Amputation ◽

The Past ◽

Amputation Surgery

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.

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Erector spinae plane block: A safe, simple and effective alternative for knee surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x19877655 ◽

2019 ◽

Vol 47 (5) ◽

pp. 469-471 ◽

Cited By ~ 2

Author(s):

Arshad Ayub ◽

Praween Talawar ◽

Santosh K Gupta ◽

Rakesh Kumar ◽

Alauddin Alam

Keyword(s):

Lower Limb ◽

Orthopaedic Surgery ◽

Knee Surgery ◽

Erector Spinae ◽

Thoracic Pain ◽

Knee Amputation ◽

Bilateral Knee ◽

Erector Spinae Plane Block ◽

Neuraxial Anaesthesia ◽

Analgesic Use

Neuraxial anaesthesia techniques are routinely used to manage postoperative pain in patients undergoing lower limb orthopaedic surgery. However, neuraxial anaesthesia is contraindicated in patients with a deformed spine or coagulopathy. Researchers recently described the erector spinae plane block—a safe, easy and effective interfascial plane block for managing chronic thoracic pain. Since then, it has been used for providing analgesia in thoracic, abdominal and hip surgery. We report its analgesic use in two patients undergoing knee surgery: one with lumbar scoliosis undergoing above knee amputation, and the other with haemophilia undergoing bilateral knee arthroplasty.

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The Role of the Lateral Malleolus as a Stabilizing Factor of the Ankle Joint: Preliminary Report

Foot & Ankle ◽

10.1177/107110078100200104 ◽

1981 ◽

Vol 2 (1) ◽

pp. 25-29 ◽

Cited By ~ 22

Author(s):

David Segal ◽

Robert Y. Pick ◽

Harvey A. Klein ◽

David Heskiaoff

Keyword(s):

Ankle Joint ◽

Lower Limb ◽

Preliminary Report ◽

Lateral Malleolus ◽

Distal Fibula ◽

Supporting Structure ◽

Knee Amputation

A preliminary report evaluating the role of the distal fibula as the lateral supporting structure of the ankle is presented. The study involved loading the knee of an above the knee amputation specimen and recording the resultant strains on the distal fibula. This was done with the ankle of the specimen in neutral, dorsiflexion, and eversion. Results show the susceptibility of the lateral fibula to compressive strains, with the greatest compression noted when the ankle is in eversion. Early findings also indicate that the fibula and lateral malleolus play an insignificant role in the weightbearing process in the lower limb.

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