Long posterior flap below-knee amputation for obliterative vascular disease of the lower limb

A study was made of 544 cases with lower limb deficiencies caused by obliterative diseases; 262 cases were below-knee amputees. Of these, 106 (40%) were amputees transferred from other clinics for prosthetic fitting; in 156 cases (60%) the amputations were performed in the Institute. Amputations were carried out using one of two techniques according to the state of arterial and collateral circulation. The posterior flap below-knee amputation (Burgess, 1969) was employed in 94 cases, the other 62 amputations were carried out using a modification of that technique which was characterized by the formation of a musculo-fascia-cutaneous flap. The stump wound healed by first intention in 127 patients (81.4%), by second intention in 18 (11.5%) and in 11 cases (7.1%) the wounds failed to heal. Successful prosthetic fitting and walking training was achieved in 91.3% of amputees and 67.2% were returned to productive work.

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The influence of smoking on the level of lower limb amputation

Prosthetics and Orthotics International ◽

10.3109/03093648709078192 ◽

1987 ◽

Vol 11 (3) ◽

pp. 113-116 ◽

Cited By ~ 17

Author(s):

C. P. U. Stewart

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

General Population ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Lower Limb ◽

Limb Amputation ◽

Peripheral Vascular ◽

Knee Amputation ◽

High Incidence

A review of smoking habits of 77 vascular related amputees demonstrated a high incidence of smoking significantly greater for men than in the general population. Male smoking amputees with atherosclerosis related peripheral vascular disease were found to have a high risk of having an above-knee amputation. Those with diabetes mellitus whether male or female, smokers or not, had a significantly greater chance of having a below-knee amputation. Overall, non-smokers were found more likely to have a below-knee amputation than an above-knee (p<0.05).

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O42: THE ROLE OF TOURNIQUETS IN TRANSTIBIAL AMPUTATION FOR PERIPHERAL VASCULAR DISEASE: A SYSTEMATIC REVIEW & META-ANALYSIS

British Journal of Surgery ◽

10.1093/bjs/znab117.042 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

D Cagney ◽

J Byrne ◽

GJ Fulton ◽

BJ Manning ◽

HP Redmond

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Revision Surgery ◽

Lower Limb ◽

Cochrane Library ◽

Peripheral Vascular ◽

Operative Blood Loss ◽

Transfusion Requirements

Abstract Introduction The use of lower limb tourniquets is traditionally discouraged in severe atherosclerotic disease. However, blood loss and increased transfusion requirements are associated with post-operative morbidity in patients undergoing major lower limb amputation. The aim of this systematic review is to summarise and pool the available data to determine the impact of tourniquet application when performing trans-tibial amputation for peripheral vascular disease. Method This systematic review was conducted according to PRISMA guidelines. A systematic search of Medline, Embase and Cochrane Library was undertaken for articles which compared the use of a tourniquet versus no tourniquet in patients undergoing trans-tibial amputation for peripheral vascular disease. The main outcomes included intra-operative blood loss, post-operative transfusion requirement, need for revision surgery and 30-day mortality. Result Four studies met the inclusion criteria for quantitative analysis with a total of 267 patients. A tourniquet was used in 130 patients. Both groups were matched for age, gender, co-morbidities and pre-operative haemoglobin. In patients undergoing trans-tibial amputation, tourniquets were associated with significantly lower intra-operative blood loss (Mean difference= -147.6mls; P=0.03) and lower transfusion requirements (pooled odds ratio (OR), 0.12, p=0.03). The need for stump revision (OR, 0.7; p=0.48), proceeding to transfemoral amputation within 30 days (OR, 0.67; p=0.25) and 30-day mortality (OR, 0.65; p=0.41) all favoured tourniquet use but the differences were not found to be significant. Conclusion Tourniquets can reduce intra-operative blood loss and transfusion requirements in patients undergoing trans-tibial amputation without increasing ischaemic complications and need for revision surgery. Take-home message Tourniquets are safe to use in trans-tibial amputation for severe peripheral vascular disease and can reduce intra-operative blood loss without increasing ischaemic complications.

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Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v38i1.44683 ◽

2019 ◽

Vol 38 (1) ◽

pp. 12-17

Author(s):

Farah Nobi ◽

Syed Al Nahian ◽

Afrin Sultana ◽

Rokhsana Sarmin ◽

Ayesha Rahman ◽

...

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Lower Limb ◽

Diabetic Foot ◽

Tertiary Care ◽

Peripheral Vascular ◽

Tertiary Care Centre ◽

Term Care ◽

Diabetic Foot Infection ◽

Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression. Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre. Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol. Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry. Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals. J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

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