scholarly journals The influence of smoking on the level of lower limb amputation

1987 ◽  
Vol 11 (3) ◽  
pp. 113-116 ◽  
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).

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

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.

scholarly journals A study on diabetic foot and its association with peripheral artery disease

2017 ◽  
Vol 4 (4) ◽  
pp. 1217 ◽  
Author(s):  
Alli Muthiah ◽  
Ramachandran Kandasamy ◽  
Nagulan S. ◽  
Aruna Madasamy
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Surgery ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Peripheral Artery Disease ◽  
Diabetic Foot ◽  
Peripheral Vascular ◽  
Peripheral Artery ◽  
Knee Amputation ◽  
Artery Disease

Background: Diabetes mellitus is characterized by high blood sugar levels over a prolonged period due to alteration in either the insulin secretion, insulin action, or both. Worldwide, as of the recent 2016 data collected from the World Health Organization (WHO) around 422 million adults have diabetes mellitus which is estimated to almost double by 2030 which is composed of mainly type 2 diabetes (85-90% of all cases). The early detection of peripheral artery disease in asymptomatic patients goes a long way in reduction of major lower limb amputations and mortality. Hence, there is a need for evaluation of peripheral vascular disease in all diabetics, especially those with diabetic foot by formulating effective management protocols, thereby limiting the morbidity, mortality and social costs associated with the disease.Methods: Patients admitted and seen in out-patient department for diabetic foot ulcers between January 2013 and October 2013 in Department of general surgery, vascular surgery and diabetology, Kilpauk Medical College Hospital, Chennai, India were taken for study.Results: 150 cases satisfying the inclusion criteria were taken up for the study from January 2013 to October 2013. Out of 150 patients, 76 patients presented with ulcer in foot, 34 presented with gangrene of toe or foot. After clinical examination it was found that 52 patients had associated neuropathy, 17 patients had ABI less than 0.3 and 39 patients had ABI in between 0.4 and 0.9. Patients with ulcer and gangrene in foot and with ABI less than 0.9 were admitted and evaluated with doppler study of lower limbs. After getting consent, appropriate procedure was done for each patient. Wound debridement was done in 21 cases, toe disarticulation in 12, fore foot amputations in 4, Below knee amputation in 9, above knee amputation in 3. 11 patients were referred to vascular surgery and underwent revascularization procedures (BYPASS).Conclusions: The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. Males have a higher predilection for developing peripheral vascular disease than females. The average age of presentation of PAD in diabetics is 40 -60 years. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment.

Lower limb amputations: Registration of all lower limb amputations performed at the University Hospital of Trondheim, Norway, 1994–1997

2001 ◽  
Vol 25 (3) ◽  
pp. 181-185 ◽  
Author(s):  
E. Witsø ◽  
H. Rønningen
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Annual Incidence ◽  
University Hospital ◽  
Peripheral Vascular ◽  
The University ◽  
The City

The authors consecutively recorded all lower limb amputations performed at the University Hospital of Trondheim from January 1st, 1994 to January 1st, 1997. A total of 215 primary lower limb amputations were carried out in the study period: 40 partial foot amputations, 2 ankle disarticulations, 51 trans-tibial amputations, 68 knee disarticulations, 50 trans-femoral amputations and 4 hip disarticulations.Seventy-four (74) (34%) of the amputees had diabetes mellitus, 113 (53%) had peripheral vascular disease and 28 (13%) of the amputees had various diagnoses. In those who were amputated due to diabetic and peripheral vascular disease the overall reamputation rate was 19% and 20%, respectively. The rates of reamputation at the trans-tibial and knee level were similar. In the city of Trondheim the annual incidence of primary amputations was 34 per 100,000 and 4.4 per 1,000 diabetic subjects. The incidence of lower limb amputations was 25 times higher in diabetic subjects compared to non-diabetic subjects.

scholarly journals A Retrospective Review of Risk Factors and Conversion Rate of Transmetatarsal Amputations to Below or Above Knee Amputation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Jefferson Sabatini ◽  
Susan Odum ◽  
J. Kent Ellington ◽  
Carroll P. Jones ◽  
W. Hodges Davis
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
High Rate ◽  
Peripheral Vascular ◽  
Knee Amputation ◽  
Tobacco Abuse ◽  
History Of ◽  
Transmetatarsal Amputation

Category: Diabetes Introduction/Purpose: Despite the presence of several studies examining the conversion from transmetatarsal amputation (TMA) to a more proximal amputation, few studies identified the possible predictors of failure. The objective of this study is to examine the rate of conversion of transmetatarsal amputation to below or above knee amputation, and to identify the risk factors for conversion. Methods: A retrospective cohort study was performed examining 71 transmetatarsal amputations performed by a single group of foot and ankle subspecialists within a single specialty group between October 1 2005 and August 25 2015. Demographic information and comorbidities were recorded, as were complications, readmission rate, and rate of conversion to a more proximal amputation. Results: Of the 71 patients who underwent transmetatarsal amputation during the study period, 74.7% progressed to a revision amputation or more proximal amputation at a mean of 9.7 months, but a median of only 3.2 months. 87.3% progressed to below knee amputation, 9.9% underwent revision transmetatarsal amputation, and 2.8% received an above knee amputation. Of the patients who progressed to more proximal amputation, 88.2% had diabetes mellitus, 72.4% had a pre-operative ulceration, and 81.7% had peripheral neuropathy. Only 52.7% had diagnosed peripheral vascular disease, 38.1% had a history of renal disease, and 35% were smokers. Conclusion: Transmetatarsal amputation has an extremely high short-term reamputation rate with the vast progressing to a below knee amputation. Comorbidities such as diabetes mellitus, neuropathy, and history of ulceration are often found in these patients, while renal and peripheral vascular disease as well as tobacco abuse are not necessarily present. This high rate of reamputation may bring into question the efficacy of performing transmetatarsal amputation as opposed to a more proximal amputation as a definitive procedure when lower extremity amputation is required.

scholarly journals The eventual outcome of patients who had lower limb amputations due to peripheral vascular disease at Pelonomi Hospital, Bloemfontein

2017 ◽  
Vol 59 (2) ◽  
pp. 47
Author(s):  
C De Klerk ◽  
G Du Plessis ◽  
J J Fourie ◽  
A O'Neill ◽  
S J A Smit ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Limb Amputation ◽  
High Morbidity ◽  
Peripheral Vascular ◽  
Contact Information ◽  
Study Population ◽  
One Year

Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011. Methods: Prospective data collection of a retrospective cohort study group was performed. Included were patients with PVDinduced LLAs. Demographic and contact information was collected from Meditech. Living status (alive or dead) was determined using the Department of Home Affairs database and interviews with relatives. Results: Of the study population (n = 224), 119 had contact information. Data of 158 people were available to determine living status: 71.5% had died by follow-up in 2014. Forty-nine interviews were possible, 31 patients had died, with cause of death reported to be primarily vascular related. The cumulative mortality showed that 16.1% died within a month and 48.4% within one year post-amputation. Among the 18 living amputees, 50.0% became unemployed, 77.8% used wheelchairs, 11.1% used crutches and 11.1% a prosthesis. Conclusion: Lower limb amputation due to PVD is indicative of a poor prognosis. In our study only 28.5% of patients survived 3–6 years post-amputation. Restoration to ideal mobility was achieved in a minority of cases. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.12481450

scholarly journals An exploratory phenomenological study exploring the experiences of people with systemic disease who have undergone lower limb amputation and its impact on their psychological well-being

2014 ◽  
Vol 40 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Elaine D Washington ◽  
Anita E Williams
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Chronic Condition ◽  
Well Being ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Peripheral Vascular ◽  
Psychological Well Being ◽  
Over Time

Background: Amputation is a life-changing event accompanied by challenges for the affected person with time-dependent depression often used to quantify its level of impact on their psychological well-being. There are varied factors that contribute to this and its persistence. The aim of this study was to explore the experiences over time of people with diabetes and/or peripheral vascular disease following an amputation and the impact on their psychological well-being. Objectives: To develop an understanding of the experience of living with an amputation and a chronic condition in order to help clinicians identify those in need of counselling support. Study design: A qualitative study utilising an iterative approach in line with the philosophy of interpretive phenomenology. Methods: Six participants who had experienced a lower limb amputation associated with peripheral vascular disease/diabetes were interviewed on two occasions (baseline and 4 months). An interpretative phenomenological approach was utilised for both data collection and analysis. Results: For these participants, amputation was part of the chronology of their chronic disease. It was the individual’s variable experience of health which impacted their psychological well-being rather than the length of time since amputation. Conclusions: The multivariable experience of amputation means that individually tailored counselling/psychological support is recommended. Clinical relevance An understanding of how the experience of living with an amputation and a chronic condition may change over time will help clinicians to identify the ongoing need for counselling support.

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