A device for tracing contour of amputation stump and extremities: the contour-tracer.
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We present a series of six patients in whom a traumatic below-knee amputation was associated with significant degloving, such that there was inadequate local skin to achieve primary stump closure. In each case, skin grafts were used to cover the stump muscle flaps. The patients ranged in age from 21 years to 73 years; the mean hospital stay was 72 days and the mean follow-up was 48 months. Despite an average of five procedures to achieve stump healing and an average of 118 days to first limb fitting, all patients have achieved independent mobility with their prosthesis. All have had minor stump problems necessitating periods of time off their prosthesis. Three patients have required minor stump-revision surgery. The advantages of a below-knee amputation over an above-knee amputation compensate for these problems. The forgiving nature of modern prostheses has contributed to acceptable results in these patients, who had what may previously have been considered insufficiently durable stump cover.
A free radical forearm flap was salvaged from a nonreplantable amputated extremity and banked on the ipsilateral chest wall. Later, the flap was simply rotated to provide coverage of the proximal humeral stump, eliminating the need for a second microvascular procedure.
The prevalence of ischaemic or infective delayed wound healing in amputations for peripheral vascular disease may vary from 18 to 40%. A prospective trial to test the efficacy of 12 h pre-operative preparation with 10% povidone-iodine was performed in a 1-year period, during which time 80 consecutive amputations were performed on 73 patients. Accrual to the treatment arm was incomplete and was principally due to extreme nursing shortages. Failure of randomization resulted in the study being analysed as if it were retrospective. Infection occurred in 14 (23%) of unprepared limbs but was not found in any of the 19 prepared limbs (P less than 0.05). Infection occurred in 11 of 34 unprepared limbs which had distal ulcers or moist gangrenous lesions; however, 15 prepared limbs which had similar distal lesions had no infection (P less than 0.025). The reduction of wound breakdown and infection resulted in a significant reduction in hospitalization prior to commencement of prosthetic fitting (P less than 0.001). Pre-operative antiseptic preparation played an important role in the reduction of infection following amputation for peripheral vascular disease, particularly for those patients whose amputation was required because of contaminated peripheral ischaemic lesions. However, these preliminary results should be confirmed by further study.
The authors describe the recently developed technique of tissue expansion to correct a problem-causing amputation scar. The technique involves the use of a progressively distended silicone bag placed under the skin to gradually stretch the skin so as to provide sufficient excess skin to allow plastic closure and elimination of the scarred tissue that had interfered with the use of a prosthesis.
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