PubMed · 13308225
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H MELEGA. Inter-ilio-abdominal amputation.. https://pubmed.ncbi.nlm.nih.gov/13308225/
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Even to the present day, hip disarticulation is one of the most radical orthopaedic operations. First carried out on the Continent in 1774 and in Britain in 1779, this procedure was only deemed necessary in circumstances where death was otherwise inevitable. George James Guthrie claimed to have undertaken the first amputation through the hip joint in which the patient survived. We describe some of these cases from the pre-anaesthetic surgical literature in which amputation through the hip joint was undertaken, and we comment on the surgical techniques used. This information is complemented by the views of certain authorities on this procedure. Many surgeons during the first half of the 19th century, including Guthrie, sought alternative surgical operations to hip joint disarticulation. The removal of the head and neck of the femur was far less traumatic than disarticulation through the hip joint, and proved an extremely effective alternative procedure for lesions involving the proximal part of the femur where there was any possibility that the limb could be saved.
The socket liner plays a crucial role in redistribution of the interface stresses between the stump and the socket, so that the peak interface stress could be reduced. However, how the peak stress is affected by various liner stiffnesses is still unknown, especially when the phenomenon of the stump slide within the socket is considered. This study employed nonlinear contact finite element analyses to study the biomechanical reaction of the stump sliding with particular attention to the liner stiffness effects of the trans-tibial prosthesis. To validate the finite element outcomes, experimental measurements of the interface stresses and sliding distance were further executed. The results showed that the biomechanical response of the stump sliding are highly nonlinear. With a less stiff liner, the slide distance of the stump would increase with a larger contact area. However, this increase in the contact area would not ensure a reduction in the peak interface stress and this is due to the combined effects of the non-uniform shape of the socket and the various sliding distances generated by the different liner stiffnesses.
BACKGROUND: Verrucous hyperplasia is a hyperplastic disease that manifests as coalescent warty papules at stump amputation sites. Often overlooked, it can be confused with verrucous carcinoma. As such, it is of concern for dermatologic surgeons. OBJECTIVE: To present a patient with verrucous hyperplasia and review its literature. METHODS: We report a 62-year-old diabetic patient with a verrucous nodule that arose at the amputation site of her first three right toes. Despite repeated surgical removals and skin graftings, the verrucous nodule redeveloped. A biopsy revealed digitate epidermal hyperplasia with dilated tortuous capillaries in thin dermal papilla without invasive features, mitotic figures, or acanthotic downgrowth. Polymerase chain reaction did not detect human papilloma virus. RESULTS: Verrucous hyperplasia secondary to amputation was diagnosed. CONCLUSION: Verrucous hyperplasia occurs should not be confused with verrucous carcinoma or warts. Moreover, because it recurs after removal, surgery is not indicated; rather, compression therapy is indicated.