PubMed · 14399092
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O HALLEN. 1959. [On a defecation phantom after rectum amputation].. https://pubmed.ncbi.nlm.nih.gov/14399092/
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Two methods to reduce the pain associated with the castration and tail docking of lambs with rubber rings were tested by 10 shepherds, each using 60 housed lambs. In 20 of the lambs the innervation to the scrotum, testes and tail was crushed with a 'Big Nipper' bloodless castrator, and in 20 local anaesthetic (2 per cent lignocaine with adrenaline) was injected with a newly developed high-pressure jet injector under the rubber rings after they had been applied; 10 lambs were given a placebo treatment and 10 were treated by the shepherds' routine elastrator ring procedure. Both new methods significantly decreased the incidence of limb and tail movement by 78 per cent and the time spent by the lambs in abnormal postures, when compared with either the shepherds' routine treatment or the placebo treatment. An experienced observer and most of the shepherds also assessed that the lambs suffered signficantly less pain when treated by the two new methods than when they were treated with rubber rings alone. No detrimental long-term effects of the two new methods were observed. On average the new methods took 68 seconds to apply, compared with 29 seconds for the rubber rings; of the two new methods most shepherds preferred using the pressure jet injector.
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BACKGROUND: Below knee amputation (BKA) may be necessary in patients with advanced critical limb ischaemia or diabetic foot sepsis in whom no other treatment option is available. There is no consensus as to which surgical technique achieves the maximum rehabilitation potential. OBJECTIVES: To look at the evidence comparing different surgical techniques for BKA using stump healing, wound infection, reamputation rate and mobility with a prosthetic limb as outcome measures. SEARCH STRATEGY: Publications describing randomised controlled trials comparing different types of incision for below knee amputation were sought using the search strategy described by the Cochrane Review Group on Peripheral Vascular Diseases. This involved searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Additional searches were made of bibliographies of papers found through these searches, and also by handsearching relevant journals. SELECTION CRITERIA: Randomised controlled trials comparing two or more types of skin incision for BKA were identified. All patients with lower limb ischaemia (acute or chronic) and/or diabetic foot sepsis were considered for inclusion. Patients undergoing below knee amputation for other conditions were excluded. DATA COLLECTION AND ANALYSIS: Three studies were included in the analysis: two-stage versus one-stage BKA; skew flaps BKA versus long posterior flap BKA; sagittal flaps BKA versus long posterior flap BKA. Data were extracted independently by both authors. MAIN RESULTS: BKA using skew flaps or sagittal flaps conferred no advantage over the well established long posterior flap technique. For patients with wet gangrene, a two-stage procedure with a guillotine amputation at the ankle followed by a definitive long posterior flap amputation leads to better primary stump healing than a one-stage procedure. REVIEWER'S CONCLUSIONS: Evidence suggests that the choice of amputation technique has no effect on outcome and can therefore be a simple matter of surgeon preference. Factors which might influence this include previous experience of a particular technique, the extent of non-viable tissue, and the location of pre-existing surgical scars.