Indications and Complications of Lower Limb Amputations (original) (raw)
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Current trends of major lower limb amputations at a tertiary care centre of Jammu, India
Aim: The aim of this study is to look for the current and any changing trends in the major lower limb amputations (LLAs) in the developing countries. Background: Amputation is the last treatment option in limbs, which are not salvageable or when the diseased limb poses a threat to the life of the patient. Indications of LLA are many, but trauma is the leading cause of major LLA in the developing nations, while as peripheral vascular disease (PVD) and diabetes is the most common indication in developed nations. Materials and Methods: This prospective study was conducted from December 2012 to October 2013 in Government Medical College, Jammu, a tertiary care center of North India. Demographic profi le of the patients along with indications, level of amputation, peri-operative complications and additional procedures required in the patients who had major LLAs during the study period were recorded. The date was analyzed by appropriate statistical tests. Results: There were 33 major LLAs performed at an average rate of 3 per month. Average age of patients was 43.5 years with 88.87% patients being males. 30.56% amputations were traumatic while as PVD and diabetes was the etiology in 19.44% and 16.67% amputations, respectively. Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Conclusion: Trauma still is the most common cause of LLAs in the developing nations, but amputations for complications of diabetes is on the rise and may be the leading etiology in future.
Current trends of major lower limb amputations at a tertiary care centre of Jammu, India, 2015
AimThe aim of this study is to look for the current and any changing trends in the major lower limb amputations (LLAs) in the developing countries. Background Amputation is the last treatment option in limbs, which are not salvageable or when the diseased limb poses a threat to the life of the patient. Indications of LLA are many, but trauma is the leading cause of major LLA in the developing nations, while as peripheral vascular disease (PVD) and diabetes is the most common indication in developed nations. Material Methods This prospective study was conducted from December 2012 to October 2013 in Government Medical College, Jammu, a tertiary care center of North India. Demographic profile of the patients along with indications, level of amputation, peri-operative complications and additional procedures required in the patients who had major LLAs during the study period were recorded. The date was analyzed by appropriate statistical tests. Results There were 33 major LLAs performed at an average rate of 3 per month. Average age of patients was 43.5 years with 88.87% patients being males. 30.56% amputations were traumatic while as PVD and diabetes was the etiology in 19.44% and 16.67% amputations, respectively. Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Conclusion Trauma still is the most common cause of LLAs in the developing nations, but amputations for complications of diabetes is on the rise and may be the leading etiology in future.
CURRENT INDICATIONS FOR MAJOR LOWER LIMB AMPUTATIONS AT CIVIL HOSPITAL, KARACHI
Objective: To find out current indications for major lower limb amputation at a tertiary care teaching hospital of Karachi -Pakistan. Methodology: Case sheets of all patients who had major lower limb amputation during six months period. Main outcome measures were patient's age, gender, limb affected, indication for amputation, complications, associated procedure performed, duration of hospital stay and outcome. Results: Total 53 patients had major limb amputation with mean age of 47.49 years. Complications of diabetes was the most common cause of limb amputation in 29 (54.7%) patients followed by trauma in 22(45.3%) patients. Most common additional procedures preformed were debridement in 26 (49%) patients, split skin grafting in four (7.5%) and vascular repair in one (1.9%) patient. Hospital stay of patients ranged from 8 to 33 days with mean duration of 17.3 days. One (1.9%) patient expired during hospital stay from sepsis. Conclusion: Complications of diabetes followed by trauma was the leading indication of major limb amputation.
Annals of vascular surgery, 2017
Amputations of lower limbs can be conducted as one-stage (OSA) or staged procedures (SA). To analyze technical success and mortality rates of both techniques, as well as factors that might influence outcomes in patients with critical limb ischemia (CLI). Retrospective study of 185 consecutive patients with CLI who underwent amputations in the period 2004-2011. Primary endpoints were rates of technical success (healing without dehiscence or reintervention), and mortality. The influence on outcomes of demographic data, clinical status, and comorbidities was also analyzed by logistic regression. A total of 101 SA (91 patients) and 106 OSA (94 patients) were analyzed. SA had proportionally higher success rate (SA 77.2% vs. OSA 66.0%, p = 0.0253), lower perioperative mortality rate (SA 10.9% vs. OSA 20.7%, p = 0.0247), and lower 30-day mortality rate (SA 12.2% vs. OSA 23.8%, p = 0.0220) in spite of more cases with Rutherford classes 5 and 6 (SA 87.1% vs. OSA 72.6%, p = 0.0047), diabetes ...
Resumo Introdução/Objetivos: A amputação é a retirada cirúrgica, total ou parcial, de um membro. Objetivos: A presente pesquisa tem por objetivo traçar o perfil epidemiológico de amputados de membros superiores e inferiores atendidos no CRER (Centro de Reabilitação e Readaptação Dr. Henrique Santillo). Métodos: Foram analisados 113 prontuários, para descrever as variáveis sexo, nível da amputação, idade e causas da amputação dos pacientes atendidos nesta instituição no período de janeiro a julho de 2011. Resultados/Conclusão: Conclui-se que ocorreu uma maior incidência dos pacientes com amputação de membros inferiores e do gênero masculino, cujas principais causas encontradas foram as doenças vasculares e os acidentes automobilísticos. Abstract Introduction/Objective: Amputation is the surgical removal of all or part of a limb. Objectives: This study aims to trace the epidemiological profile of amputees of upper and lower limbs treated at CRER (Center for Rehabilitation and Readaptation Dr. Henry Santillo). Methods: We analyzed 113 folders in order to describe the gender, level of amputation, age and cause of amputation of the patients treated at this institution from January to July 2011. Results/Conclusion: We conclude that there was a higher incidence of patients with lower limb amputation and males. The main causes found were vascular diseases and car accidents.
Amputation is one of the oldest surgical procedure and a good amputation results in optimal functional outcome by providing healthy residual limb. Advances in prosthetics has enabled amputee with diverse options and better functionality. There is also decrease in the overall burden of amputation as a result of better treatment of causative disorders and proper limb salvage techniques. Complications, however, pose challenges in regain of necessary functions and include an array of disorders related to the procedure, technique and other factors. An understanding of common and practical complications is helpful in their anticipation and relevant prohibitive measures. Apart from it, a comprehensive study that highlights pattern of amputations and related complications provides database for preventive and management strategy. A total of 69 cases of extremity amputations were included within a defined period of Jan 2011 to June 2016. Relevant demographic data were noted along with other details amputation and complications. An attempt is also made for co-morbidities associated in cases with complications. Males (88.40%) and lower extremity (66.66%) were involved more commonly than females and upper extremity. Below knee was commonest (50.72%) lower and below elbow along with digital amputations were commonest (15.94% each) upper extremity amputations. The significant complication that required increased hospital stay or additional procedures were noted in 34 (49.27%) cases. Delayed wound healing, wound dehiscence, painful neuroma, stiffness, exposed bone and phantom pain were some of major complication noted in the study. A brief notes on patient characteristics has been attributed to the nature of trauma, co-morbidities and substance abuse among the complicated cases. The early recognition of complication and prompt management goes a long way in abetment of agony and discomfort of patient affecting overall outcome.
The Scope of Non-Trauma Lower Limb Amputations at the Komfo Anokye Teaching Hospital, Kumasi-Ghana
MOJ Orthopedics & Rheumatology, 2015
Background: Lower limb amputation has a significant impact on the quality of life of the affected individual and family. Non-trauma amputations are the result of neglected public health conditions like complications of Diabetes mellitus, peripheral arterial disease and malignancies. The incidence of non-trauma amputation is increasing in Ghana mainly due to these non-communicable diseases which can be ascribed partially to changing lifestyles. Objective: The objective of this study is to determine the demographic profile of nontrauma amputees, indications and patterns of amputation, duration of symptoms before reporting to hospital, reasons for delay in seeking medical care, and length of hospital stay from admission to discharge. Methods: A prospective cross sectional study was carried out at the General Surgery Unit of the Komfo Anokye Teaching Hospital from November 2012 to October 2014. All patients on admission who had undergone lower limb amputation for non-trauma indications were interviewed using structured questionnaire. Their clinical notes were used to collect extra information on clinical management data to satisfy the set objectives. Data was analyzed with Epi Info version 3.5.1. Results were presented using simple descriptive statistics. Ethical clearance was obtained from CHRPE. Results: A total of 104 patients underwent amputation for non-trauma indications during the period under study. The mean age of respondents was 65years ± 14.7 SD with a Male: Female ratio of 1.6:1. Majority; 85 (81.7%) had either no formal education or only primary education while 71 (68.3%) were employed in the informal sector (mainly farmers, artisans and traders). Twenty-three (22.1%) were unemployed and 1 (0.9%) was a student. The indications for non-trauma amputations were diabetic leg ulcers; 55 (52.9%), peripheral arterial disease; 42 (40.4%), malignancies; 6 (5.7%), and post-burn contracture; 1 (0.9%). The pattern of amputation were above knee amputation; 64 (61.5%), below knee amputation; 23 (22.1%), Rays amputation of the toe; 15 (14.4%) and 2 (1.9%) Hip de-articulation. Sixteen (15.4%) presented within 3 months of onset of symptoms, while 57 (54.8%) presented between 3-6 months and 31 (29.8.0%) after 6 months. Reasons for delayed presentation were: home treatment with herbs; 43 (41.3 %), fear of having limbs amputated; 25 (24.0%), financial constraints; 16 (15.4%), lack of nearby health facilities; 5 (5.4) % and others. The duration of hospital stay was from 4-86 days with a mean of 17.53 ±14.83SD. Conclusion and Recommendation: This study concluded that complications of diabetes mellitus were the major indication for non-trauma amputations in KATH. Above knee amputation was the commonest pattern of amputation. Majority of patients presented between 3-6 months of onset of symptoms. Commonest reason for delayed presentation to hospital was the preference of herbal medications to hospital treatment. Duration of hospital stay from admission to discharge was approximately 5 weeks. It is recommended from evidence gathered from this study that proper attention should be given to improving the awareness and quality of care of diabetes mellitus to minimize its complications leading to non-trauma amputations.
Cureus, 2021
To identify the amputation rates and causative factors for failed revascularization leading to amputation in patients undergoing primary limb salvage procedures for lower-extremity vascular injuries. Methods This retrospective study was conducted at the vascular surgery department, Shaheed Mohtarma Benazir Bhutto (SMBB) Institute of Trauma, Karachi, Pakistan. The data were collected from hospital record using the non-probability sampling technique. Patients aged 17-70 years, undergoing primary revascularization during April 2016 to March 2021, were included in the study. Patients with crush injuries/non-salvageable limbs underwent primary amputation, isolated deep femoral artery or crural arteries (non-limb threatening) injuries, and non-traumatic injuries like intravenous drug-induced or iatrogenic injuries were excluded. The data analysis is done using SPSS Version 20.0 (IBM Corp., Armonk, NY, USA). A P-value of <0.05 was considered as significant. Results This study includes 56 patients of mean age 30.82 ± 9.29 years with male gender four times more affected than their counterpart. About 32% of patients were smokers, while 58% of patients had no co-morbidities. All patients presented with a mean time of 7.66 ± 1.69 hours of injury with an average of 1.14 arterial segments involved. The most frequent artery involved was popliteal artery (both above and below the knee), followed by superficial femoral artery injury constituting 50% and 26%, respectively, with arterial laceration and transection being common findings on exploration. Out of 56 patients, 27 (48.2%) had open fractures, 21 (37.5%) closed fractures, and eight patients (14.3 %) presented with dislocation as associated injuries. Following the procedure, secondary amputation was recorded in 18 (32.1%) patients. Thrombosis and infection were the leading causes of revascularization failure. Type of injury, segment of arterial injury, and associated bony injuries were associated with limb amputation. Conclusion Type and site of injury along with concomitant bony injuries are associated with major amputations after revascularization in lower-extremity arterial injuries.