scholarly journals Predictors for reoperation after lower limb amputation in patients with peripheral arterial disease

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 419-424 ◽  
Author(s):  
Martin C. Berli ◽  
Florian Wanivenhaus ◽  
Method Kabelitz ◽  
Tobias Götschi ◽  
Thomas Böni ◽  
...  
Keyword(s):  
Wound Healing ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Balloon Angioplasty ◽  
Revision Surgery ◽  
Lower Limb ◽  
Arterial Disease ◽  
Limb Amputation ◽  
Amputation Level ◽  
Peripheral Arterial

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.

scholarly journals Lower Limb Amputation Rates in Germany

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 101
Author(s):  
Nike Walter ◽  
Volker Alt ◽  
Markus Rupp
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Amputation Level ◽  
Patient Optimization ◽  
Peripheral Arterial ◽  
Extremity Amputation

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.

Lower limb wounds in diabetes: the challenges of wound healing

2021 ◽  
Vol 26 (Sup9) ◽  
pp. S20-S24
Author(s):  
Krishna Gohil
Keyword(s):  
Wound Healing ◽  
Peripheral Arterial Disease ◽  
Patient Outcomes ◽  
Lower Limb ◽  
Holistic Approach ◽  
Arterial Disease ◽  
Delayed Wound Healing ◽  
Early Referral ◽  
Peripheral Arterial

Managing ulceration in the lower limb for a patient with diabetes can be complex and challenging, requiring a multiprofessional, patient-centred, holistic approach with early referral for specialist review as key. Any delay in referral and intervention can be catastrophic, as time is tissue. Peripheral arterial disease and neuropathy both contribute significantly to the delays in wound healing, and it is important to rapidly recognise the problems with an informed assessment and understand the possible reasons for delayed wound healing, so that management is appropriate, rapid referrals are made and patient outcomes are optimised. This article discusses some of the reasons why wound healing is complicated in those with diabetes as a comorbidity.

scholarly journals The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation

2016 ◽  
Vol 41 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Fiona Davie-Smith ◽  
Lorna Paul ◽  
Natalie Nicholls ◽  
Wesley P Stuart ◽  
Brian Kennon
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Clinical Relevance ◽  
Arterial Disease ◽  
Lower Extremity Amputation ◽  
Amputation Level ◽  
Prosthetic Limb ◽  
Peripheral Arterial ◽  
Extremity Amputation

Background: Diabetes mellitus is a leading cause of major lower extremity amputation. Objective: To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease. Study design: Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset. Results: Within the cohort with peripheral arterial disease ( n = 1735), 64% were men ( n = 1112) and 48% ( n = 834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1 years, respectively ( p < 0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation ( p = 0.001) and trans-femoral amputation ( p = 0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb ( p < 0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level ( p < 0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level. Conclusion: Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus. Clinical relevance This is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.

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