Biomedical subjects

J L Rowbotham

Publications and source records attributed to J L Rowbotham.

11 recordsLinked to original sources

PubMed1990

Review of metatarsal osteotomies for the treatment of neuropathic ulcerations.

The records of 52 patients who underwent metatarsal osteotomies for the treatment of chronic neuropathic ulcerations between the years 1983 and 1985 were analyzed in a retrospective study. Long-term follow-up information was available for all but three patients. All patients were conservatively managed preoperatively and postoperatively with shoes, accommodative orthoses, and local care. A limb salvage rate of 94%, 46 of 49 patients, was achieved in this study. Although 13 patients developed transfer ulcerations, all but one were managed either with conservative care or a lesser podiatric procedure, and all remain healed to date.

Adult↗

PubMed1985

Improved results with diabetic below-knee amputations.

This study of 100 consecutive below-knee amputations in 98 diabetic patients was undertaken to review our results and to compare them with a similar report of 20 years ago. Ninety-three limbs were ischemic, and 79% of the patients had significant infection. This finding was similar to that in our previous study group. Twenty-one percent of the patients had previous arterial reconstruction, 11% had had a toe or metatarsal amputation, and 17% required a guillotine (open) amputation to control sepsis. The below- to above-knee amputation ratio was 2.3/1. The selection of level was made on clinical grounds. None of the 100 amputations required revision to above-knee amputation. The mortality rate was 3% and the wound complication rate was 18%. Eighty-three percent of the patients were ambulatory at the time of discharge, which occurred at an average of 35 days. There has been a significant improvement in the number of successful below-knee amputations performed since our previous study. We attribute these results to aggressive surgical control of infection and to close follow-up with early recognition and treatment of healing problems.

Adult↗

PubMed1983

Problems of the diabetic foot. Diabetes and amputations.

Explore the source record for details and available documents.

Amputation, Surgical↗

PubMed1979

Predicting success of forefoot amputations in diabetics by noninvasive testing.

Sixty-six diabetic patients underwent needed forefoot amputations when clinical assessment indicated a reasonable chance of healing. All patients underwent noninvasive testing consisting of segmental systolic pressure measurements and pulse volume recordings (PVRs) taken at the thigh, calf, ankle, and forefoot levels. Segmental systolic pressures were falsely high (greater than 200 mm Hg) and therefore not useful in 56%. Ankle systolic pressures predicted failure in 36% of patients who healed and success in 64% who failed to heal. Segmental PVRs were sequentially predictive in only 50%. Forefoot PVR traces predicted failure in 50% of patients whose amputations healed. No patient should be denied a forefoot amputation solely on the basis of unfavorable results of noninvasive tests. Favorable clinical signs and a strongly positive forefoot PVR trace are the best predictors of successful forefoot amputations in diabetic patients.

Amputation, Surgical↗

PubMed1979

Noninvasive prediction of amputation level in diabetic patients.

Noninvasive laboratory testing was used to predict successful amputation levels in 150 diabetic patients. The cases of 100 patients undergoing forefoot amputation and 50 patients undergoing below-knee amputation were evaluated using segmental systolic pressures and pulse volume recordings (PVRs). The decision for and the level of amputation were based solely on clinical judgment. In patients undergoing forefoot amputation, segmental systolic pressures were falsely high or predicted incorrectly in over half the cases. Segment PVRs were correctly predictive in only half of the cases. In patients undergoing below-knee amputation, segment systolic pressures were falsely high or predicted incorrectly in over one third of cases. Segmental PVRs were correctly predictive in less than one third of the cases. In the diabetic patient, clinical judgment continues to provide the most accurate and reliable information by which the type of amputation and likelihood of its success can be judged.

Adult↗

PubMed1975

Advances in rehabilitation of stoma patients.

The rehabilitation of people with abdominal stomas depends upon a good stoma well placed, the guidance of an enterstomal therapist, and the availability of a clinic staffed with a multidisciplinary group to recognize and meet the continuing needs of stoma patients.

Colostomy↗

PubMed1974