[The length of the femoral amputation stump in relation to the early use of laminated adherent prosthesis].
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Patients with short, traumatic, below-the-knee amputations (BKAs) frequently function as if they have knee disarticulations. The goal of this study was to evaluate the results in patients who had lengthening of their BKA stumps to improved prosthesis fit and increase ambulation. Three patients with traumatic BKAs, who were left with insufficient stumps for proper prosthesis wear, have had their stumps lengthened by Ilizarov's technique of distraction osteogenesis. The lengthening process produced a moderate degree of pain, and all patients had a temporary decrease in their range of motion. Two patients lost a substantial amount of gained length secondary to early full weight-bearing. Despite these difficulties, the procedure produced longer, more durable stumps in all patients with no final loss of knee range of motion.
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Blood rheology was compared in two groups of patients with ischemic heart disease (IHD). In group 1 patients low limbs were amputated. It is in them that rheological properties of blood were changed to the most extent. This is attributed to the effect of plasmic factors in the form of hypertriglyceridemia and hyperfibrinogenemia, sharp reduction of the total cross sectional vascular area (especially in high amputation) leading to blood cell damage associated with intensive platelet aggregation and red cell microhemolysis. Reduced muscular mass and resultant reduced capillary bed and deficiency of endothelial surface may stimulate accumulation of triglyceride-enriched very low density lipoproteins.
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A woman, 29 years of age, sustained a below knee amputation following injury and was left with a stump 5.5 cm long. Good soft tissue cover was obtained with a myocutaneous flap using the gastrocnemius muscle and heel pad flap from the injured leg. The stump was then lengthened by 7 cm, to 12.5 cm, using the Ilizarov distraction technique. The patient was able to bear weight on the end of the fixator during the 8 months it was in position. The gap filled with bone and there were no complications. She recovered good function.