scholarly journals 751 Preoperative Factors Influencing Functional Rehabilitation After Major Lower Limb Amputation

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Premnath ◽  
M Cox ◽  
A Hostalery ◽  
G Kuhan ◽  
T Rowlands ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Lower Limb ◽  
Arterial Disease ◽  
Functional Mobility ◽  
Limb Amputation ◽  
P Value ◽  
Rehabilitation Centre ◽  
Functional Rehabilitation ◽  
Peripheral Arterial ◽  
Preoperative Factors

Abstract Introduction To identify the preoperative factors that influence functional rehabilitation after Major Lower Limb (MLL) amputation. Method This retrospective study analyzed all patients referred post-amputation to an amputee rehabilitation centre over a period of 1 year. The level of functional outcome at 6 and 12 months were recorded using SIGAM (Special Interest Group in Amputee Medicine) grading. Data on various preoperative factors were collected and analyzed for association with functional outcome. Results A total of 71 cases were analyzed. The mean age was 65.18 (range 24 - 91) years and 45 were males (63.4 %). Peripheral arterial disease was the major cause of amputation (80.3%). The level of amputation was above / through knee in 60.6%. Contralateral limb problems were present in 28.2%. Functional mobility was achieved by 38% of the MLL amputees within 6 months of rehabilitation, which increased to 46.5% at 12 months. Pre amputation mobility was a significant factor for a good functional outcome (p-value 0.002). An increasing value of BLARt (Blatchford Leicester Allman-Russell Tool) score showed a significant correlation with poor functional outcome. Conclusions Pre amputation mobility and BLARt score can be used in the prediction of functional outcome and can aid in better pre-operative decision making and rehabilitation planning.

scholarly journals Postservice lower limb amputation in Scottish military veterans

2021 ◽  
pp. bmjmilitary-2020-001720
Author(s):  
Beverly P Bergman ◽  
DF Mackay ◽  
JP Pell
Keyword(s):  
Lower Limb ◽  
Later Life ◽  
Arterial Disease ◽  
Lower Limb Amputation ◽  
Health Study ◽  
Limb Amputation ◽  
Veterans Health ◽  
Cox Proportional Hazard ◽  
Peripheral Arterial

IntroductionRecent attention has focused on veterans who have lost limbs in conflict, but the number of UK veterans who lose limbs to disease is unknown. We used data from the Trends in Scottish Veterans’ Health study to explore postservice lower limb amputation.MethodsWe carried out a retrospective cohort study of 78 000 veterans and 253 000 non-veterans born between 1945 and 1995, matched for age, sex and area of residence. We used survival analysis to examine the risk of amputation in veterans compared with non-veterans, and explored associations with antecedent disease.ResultsWe found no difference between veterans and non-veterans in the risk of lower limb amputation, which was recorded in 145 (0.19%) veterans and 464 (0.18%) non-veterans (Cox proportional hazard ratio (HR) 1.00, 95% CIs 0.82 to 1.20, p=0.961). Peripheral arterial disease was recorded in two-thirds of both veteran and non-veteran amputees, and type 2 diabetes in 41% of veterans and 33% of non-veterans, with a dual diagnosis in 32% of veterans and 26% of non-veterans. Trauma was an infrequent cause of amputation.ConclusionsAlthough in later life veterans are no more likely to lose a limb to disease than non-veterans, the number so affected greatly outweighs those who have lost limbs in conflict. The high public profile of conflict-related limb loss risks eclipsing the needs of veterans with disease-related loss. Support for ageing veterans who have lost limbs due to disease will require planning with the same care as that afforded to the victims of conflict if inequalities are to be avoided.

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.

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