scholarly journals Wound healing complications following major amputations of the lower limb

1982 ◽  
Vol 6 (2) ◽  
pp. 105-107 ◽  
Author(s):  
J. Steen Jensen ◽  
T. Mandrup-Poulsen ◽  
M. Krasnik
Keyword(s):  
Wound Healing ◽  
Lower Limb ◽  
Wound Healing Problems

A series of 320 amputations was analyzed with regard to wound healing complications and re-amputation rates. Among 111 AK amputations complications in wound healing were encountered in 14 per cent (15/111) of the cases, leading to re-amputation in 2 per cent (2/111). TK amputations were followed by wound healing problems in 30 per cent (20/66) of the cases with re-amputation in 20 per cent (13/66) at AK level, as compared to 40 per cent (57/143) with wound healing complications and 20 per cent (28/143) re-amputations in BK-amputees. As failure of BK amputation leads to re-amputation at AK level it is recommended that the TK level be selected in doubtful cases.

scholarly journals Reamputation rates, morbidity and rehabilitation after lower limb amputations

2019 ◽  
Vol 6 (4) ◽  
pp. 1274
Author(s):  
Nishish Vishwakarma ◽  
Babar Rehmani ◽  
Atul Agarwal ◽  
Jitendra Prasad Ray
Keyword(s):  
Wound Healing ◽  
Lower Limb ◽  
Limb Amputation ◽  
Age Group ◽  
E Coli ◽  
Knee Amputation ◽  
Amputation Stump ◽  
Wound Healing Problems ◽  
Male Patients

Background: This study attempted to document the indications for lower limb amputation (LLA) and its outcomes especially the wound healing problems, reamputations and subsequent use of prosthesis for mobilization in Indian population.Methods: This observational study included 92 patients over a period of 18 months. Indications, level of LLA, morbidity and reamputation rates after LLA were recorded. Stump status, wound healing and other morbidity was followed over period of one month. The use of prosthesis and level of mobility were assessing in follow-up over a period of six months.Results: There were total 109 LLA in 92 patients as some of these patients had to undergo revision of amputation stump at a higher level. Atherosclerosis (29.3%) was the main cause for LLA. Age group 35-55 years and male patients were most commonly needed LLA. Total 64.13% patients developed post-operative wound infection and 18.4% patients underwent reamputation. E. coli and Staphylococcus were the most common organism cultured from the infected surgical site. Conversion of below knee amputation (BKA) to above knee amputation (AKA) was the most frequent reamputation and atherosclerosis was the leading cause. According to final level LLA, 54 had major amputations (above ankle joint), only 37% were using a prosthesis whereas majority of patients were dependent on crutches/walker.Conclusions: Patients of atherosclerosis and trauma had a higher frequency of reamputations. Only 37% of major LLA opted for prosthesis whereas majority of patients mobilize by other means like crutches or walker. 

scholarly journals Clinical rehabilitation of the amputee: A retrospective study

1996 ◽  
Vol 20 (2) ◽  
pp. 72-78 ◽  
Author(s):  
G. M. Rommers ◽  
L. D. W. Vos ◽  
J. W. Groothoff ◽  
W. H. Eisma
Keyword(s):  
Wound Healing ◽  
Lower Limb ◽  
Oncology Group ◽  
Medical Record Data ◽  
Rehabilitation Outcome ◽  
Admission Time ◽  
Prosthetic Fitting ◽  
Record Data ◽  
Wound Healing Problems ◽  
Lower Limb Amputee

The aim of this study was to determine the rehabilitation outcome of lower limb amputee patients after clinical rehabilitation. Altogether 183 amputee patients admitted for clinical rehabilitation in the years 1987–1991 were reviewed by retrospective analysis of medical record data. Three groups of amputee patients were identified by reason for amputation. The vascular group: (N = 132), mean age 67 years, mean admission time 119 days, 85% prosthetic fitting. The oncology group (N = 15), mean age 55 years, mean admission time 77 days, 60% prosthetic fitting. The traumatic amputee group: (N = 14), mean age 41 years, mean stay 134 days and 100% prosthetic fitting. Some 22 patients were bilateral amputees and were assessed separately. The most important reasons for not fitting a prosthesis were oncological metastases, stump and wound healing problems. After rehabilitation 86% of all patients could be discharged home. These results are more favourable than those seen in previous studies.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

Deep dissecting haematoma in patients with dermatoporosis: implications for home nursing

2021 ◽  
Vol 26 (Sup3) ◽  
pp. S6-S13
Author(s):  
Valentina Vanzi ◽  
Elena Toma
Keyword(s):  
Wound Healing ◽  
Emergency Management ◽  
Lower Limb ◽  
Essential Role ◽  
Early Recognition ◽  
Wound Management ◽  
Home Nursing ◽  
High Prevalence ◽  
Clinical Emergency

Dermatoporosis is a chronic cutaneous insufficiency/fragility syndrome with a high prevalence in older adults. Dermatoporotic skin becomes thin and fragile and tends to tear. It may lead to deep dissecting haematomas (DDHs) as a final stage of dermatoporosis, which is a clinical emergency. Management can be challenging, as patients with lower-limb haematomas are frequently older and affected by multiple comorbidities, or are probably on medications that negatively influence wound healing. This article describes the essential role of nurses in prevention, early recognition and wound management of DDHs in patients with dermatoporosis.

Comparative Results of Percutaneous Calcaneal Osteotomy in Correction of Hindfoot Deformities

2018 ◽  
Vol 40 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Natalia Gutteck ◽  
Alexander Zeh ◽  
David Wohlrab ◽  
Karl-Stefan Delank
Keyword(s):  
Wound Healing ◽  
Standard Technique ◽  
Percutaneous Technique ◽  
Level Of Evidence ◽  
Calcaneal Osteotomy ◽  
Scale Scores ◽  
Oblique Incision ◽  
Hindfoot Deformities ◽  
Wound Healing Problems ◽  
The Difference

Background: Calcaneal osteotomies are often required in the correction of hindfoot deformities. The traditional open techniques, which include a lateral or oblique incision, are occasionally associated with wound healing problems and neurovascular injury. Methods: A total of 122 consecutive patients who underwent a calcaneal osteotomy for hindfoot realignment treatment were included. Fifty-eight patients were operated using an open incision technique and 64 patients (66 feet) using a percutaneous technique. Clinical and radiologic assessments were performed preoperatively, at 6 weeks, and 1 year postoperatively. Results: The American Orthopaedic Foot & Ankle Society scale scores and visual analog scale pain scores improved in both groups postoperatively. The difference between the groups was not significant. The results of the radiologic measurements pre- and postoperatively were not significantly different. No pseudarthrosis occurred in either group. The comparison of both groups showed a significantly lower risk for wound healing problems in the percutaneous group. The hospitalization time was significantly shorter in the percutaneous group. Conclusion: Because of the excellent results with the percutaneous calcaneal osteotomy, the authors feel encouraged to establish this procedure as a standard technique for calcaneus osteotomy, especially patients at high risk for wound healing problems. Level of Evidence: Level III, comparative series.

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.

Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma

2021 ◽  
Vol 103-B (12) ◽  
pp. 1802-1808
Author(s):  
Julie Bruce ◽  
Ruth Knight ◽  
Nick Parsons ◽  
Ria Betteridge ◽  
Amy Verdon ◽  
...  
Keyword(s):  
Wound Healing ◽  
Surgical Site Infection ◽  
Clinical Assessment ◽  
Lower Limb ◽  
Open Fracture ◽  
Alternative Methods ◽  
Site Infection ◽  
Limb Fracture ◽  
Wound Photography ◽  
Level Of Agreement

Aims Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. Methods Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. Results Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). Conclusion Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J 2021;103-B(12):1802–1808.

scholarly journals A Comparative Study of Two Different Techniques for Calcaneal Displacement Osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Natalia Gutteck
Keyword(s):  
Wound Healing ◽  
Complication Rate ◽  
Operating Time ◽  
Senior Author ◽  
Open Technique ◽  
Displacement Osteotomy ◽  
Osteotomy Technique ◽  
Oblique Incision ◽  
Hindfoot Deformities ◽  
Wound Healing Problems

Category: Hindfoot Introduction/Purpose: The lateral oblique incision is widely used for calcaneal displacement osteotomy in correction of hindfoot deformities. Wound healing problems and neurovascular injury are limitations of this procedure. A technique using a Shannon burr for calcaneal displacement osteotomy was introduced to avoid these complications. The advantages of the percutaneos calcaneus osteotomy have been evaluated in a comperative study. Methods: Lateral oblique incision for calcaneus osteotomy was performed in 58 patients. The senior author changed the osteotomy technique 2014. Further 64 calcaneus osteotomies were performed percutaneously. The main indication for the calcaneus osteotomy was correction of hindfoot deformities. Complementary the number of screws used for the fixation have been axamined in the study. Results: The mean age of the patients was 51,6 (14-72) years. The patients were folled up for 12 months. All cases achieved radiographic union. Wound healing problems have been registrated in the open technique group in 16 patients (27,6%). Six of them (10,3%) required a surgical revision. No wound healing problems appeared in the percutaneous group. N. suralis was affected in the open technique group in 12 patients (20,6%) and in 4 patients (6,2%) in the percutaneous osteotomy group (p 0,02). The operating time was significantly shorter in the percutaneus osteotomy group. The correction of the hindfoot axis succeed in all patients. Risk of complication did not differ significantly between single and double screw in the percutaneous osteotomy group. Conclusion: The clinical and radiological examinations showed outstanding results. There is no evident difference between the two techniques in the radiological results. Use of a single screw in percutaneous osteotomy of the calcaneus did not increased the complication rate. The percutaneous calcaneal osteotomy had a lower complication rate in our study and is probably a useful technique in patients with diabetes and affected perfusion. Further randomised studies should consider this results.

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