Reorganization of the primary motor cortex following lower-limb amputation for vascular disease: a pre-post-amputation comparison

Objectives. To explore the coping strategies used following a lower limb amputation and their relationship to adjustment in the hospital, rehabilitation, and home setting. Method. Sixteen individuals who had a lower limb amputation due to vascular disease completed questionnaires, including the Ways of Coping Questionnaire (WCQ), during hospitalization (T1), at the end of rehabilitation (T2), and 2-3 months after discharge from rehabilitation (T3). A subsample (n=10) also participated in three semistructured interviews analyzed using the approach of Miles and Huberman. Results. Self-controlling was the coping strategy used most, followed by seeking social support and positive reappraisal. Three additional coping strategies not found in the WCQ were identified in the qualitative data: noticing progress, learning new things, and using humor. Confrontive coping (T1) and escape-avoidance (T1, T2, and T3) were related to adjustment problems while positive reappraisal (T1 and T3), seeking social support (T1 and T3), and planful problem solving (T3) were associated with positive adjustment. Conclusion. Coping strategies used to deal with the amputation seem to vary across settings, thus signifying the complexity of the coping process following a lower limb amputation due to vascular disease.

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Reorganization in the ipsilateral motor cortex of patients with lower limb amputation

Neuroscience Letters ◽

10.1016/s0304-3940(03)00838-3 ◽

2003 ◽

Vol 349 (3) ◽

pp. 187-190 ◽

Cited By ~ 31

Author(s):

Peter Schwenkreis ◽

Burkhard Pleger ◽

Beate Cornelius ◽

Ute Weyen ◽

Roman Dertwinkel ◽

...

Keyword(s):

Motor Cortex ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation

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Phantom Pain in Major Lower Limb Amputation: Primary Ligation Cauterization vs Traction Neurectomy

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.887 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Ahmad Redzuan Arshad ◽

Nazri Mohd Yusoff

Keyword(s):

Vascular Disease ◽

Peripheral Vascular Disease ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Phantom Pain ◽

Peripheral Vascular ◽

Primary Amputation ◽

Group A ◽

Group B

Introduction: Phantom Limb Pain (PLP) is haunting amputees in silent. Neuroma hyperexcitability is one of the popular peripheral theories which can be addressed during primary amputation by orthopaedic surgeons. There was no study comparing type of neurectomy association with PLP. The objective was to compare the occurrence of PLP between conventional and alternative techniques of neurectomy in major lower limb amputations. Materials and Methods: A prospective, randomized, interventional study was conducted involving 98 patients in Hospital Kuala Lumpur requiring major lower limb amputation due to diabetic complication, tumor and trauma from October 2016 to June 2017. Patients were evenly randomized into two groups; Group A: conventional traction neurectomy (CTN) and Group B: ligation and cauterization neurectomy (LCN). End point of the study was the outcome of PLP which was assessed clinically at post-operative day 3, 14 and 6-month. Results were analyzed using univariate and multivariate simple logistic regression. Results: There were have 47 and 46 patients in Group A and B respectively. Of these, 70.2% in Group A (n=33) and 28.3% in Group B (n=13) end up with PLP (p<0.001). Sixty nine percent of patients who underwent amputation above knee level (n=20) suffered from PLP (p<0.05). Group B patients had higher mean PLP pain score (3.31 and 2.94) but it was not statistically significant. 69.6% of patients with pre-operative pain (n=32) and 43.5% with peripheral vascular disease (n=20) developed PLP (p<0.05). Conclusion: LCN has 0.1 chance to develop PLP compared to CTN. Other significant factors in those who developed PLP include levels of amputation, pre-operative pain and peripheral vascular disease. LCN should be considered in primary amputation.

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