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PubMedDate not supplied

Histopathology of intact and docked pigtails.

A histological examination was performed on tails from three groups of pigs, comprising 10 amputated tail tips from day-old piglets, 10 tails from undocked fattening pigs and 20 tails from docked fattening pigs. The investigation demonstrated that peripheral nerves could be traced to the tip of the tails of day-old piglets as well as of fattening pigs. In the docked fattening pigs, the peripheral nerves were unevenly distributed and showed regressive changes. In some cases traumatic neuromas were found, indicating an increased sensitivity to pain in the amputation stump. It was, surprisingly, demonstrated that widespread inflammatory reactions could be found in the apparently healthy tails of both categories of fattening pigs, presumably due to pen-mates' chewing activities.

Amputation Stumps↗
PubMed2001

Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury.

Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.

Adult↗
PubMed1986

Regeneration of growth plates in the long bones of the neonatal rat hindlimb.

Twenty-seven male albino rats underwent hindlimb amputations through the lower femur or the midshaft of the tibiofibula on the tenth to 12th day of life. Amputation stumps were examined grossly and histologically in order to assess the significance of level and angle of transaction as determinants of subsequent growth and regeneration and to ascertain whether growth plates can regenerate following their complete excision. Amputees survived for 17-73 days. In order to exclude limbs which had been severed at or distal to the level of the growth plate, amputated limb segments either were cleared to transparency and inspected under low magnification or were sectioned serially and examined by using a compound microscope. Following amputations through the femur, the predominant response involved repair of the skeletal defect and healing of adjacent soft tissues (ten of 17 rats). Among five other animals the skeletal terminus was covered with a plate of cartilage which, in three, included areas of growth-plate architecture. Two additional transfemoral amputees regenerated incomplete growth plates, each overlying a single epicondylar surface, and one provided with a regenerated hemiepiphysis. Five of ten transtibiofibular amputees formed cartilage plates which covered the skeletal terminus in whole or in part and one regenerated an entire growth plate restricted to the distal fibula. It is concluded that angle and level of transection are not pivotal modifiers of growth and regeneration processes, and that distal growth plates may regenerate entirely or in part following their complete removal from the hindlimb.

Amputation, Surgical↗
PubMed1996

Is hyperbaric oxygen a useful adjunct in the management of problem lower extremity wounds?

Hyperbaric oxygen (HBO) is currently being used in the treatment of nonhealing or "problem" wounds of the lower extremities. In an attempt to evaluate the efficacy of HBO in problem wounds, a retrospective study of the HBO experience at Orlando Regional Medical Center was conducted. From 1989 to 1994, fifty-four patients with nonhealing lower extremity wounds resulting from underlying peripheral vascular disease and/or diabetes mellitus were treated with HBO. Wounds were grouped into the following five categories: (1) diabetic ulcers (n = 17 [31%]); (2) arterial insufficiency (n = 8 [15%]); (3) gangrenous lesions (n = 6 [11%]); (4) nonhealing amputation stumps (n = 13 [24%]); and (5) nonhealing operative wounds (n = 10 [19%]). Each patient received an average of 30 treatments. Outcomes for all 54 patients treated with HBO in this study were dismal. None of the patients experienced complete healing, six (11%) showed some improvement, 43 (80%) showed no improvement, and in five cases (9%) results were inconclusive because these patients underwent concomitant revascularization or amputation. Thirty-eight of the 43 patients who showed no improvement (88%) ultimately required at least one surgical procedure to treat their wounds. Thirty-four patients (63%) developed complications, most commonly barotrauma to the ears, which occurred in 23 patients (43%). The average cost of 30 HBO treatments was $14,000 excluding daily inpatient charges. Based on the experience with HBO therapy at Orlando Regional Medical Center and the paucity of good supporting literature, it is difficult to justify such an expensive, ineffective complication-prone treatment modality for problem extremity wounds.

Amputation Stumps↗
PubMed1999

[Neurocutaneous flap of the anteromedial aspect of the thigh with a distal pedicle. Anatomical study and clinical application].

The authors report an anatomic study of the vascularization of the medial aspect of the thigh on 21 cadaveric dissections with injection. They describe a neuro-cutaneous medial thigh flap, with a distal pedicle, vascularised by proximal branches of the saphenous artery (branch from the descending genicular artery). This flap includes the medial femoral cutaneous nerve, which runs with a supra-aponeurotic vascular network. The anatomic variants and harvesting technique of this flap are described. Our clinical experience is based on 3 patients operated between 1996 and 1998, for coverage of an amputation stump. The results were excellent in all cases with a follow-up of 6 months to 3 years. The good quality of this skin coverage allows satisfactory adaptation of the leg prosthesis in our cases.

Adult↗
PubMed2002

Microsurgical free flap transfer to amputation sites: indications and results.

A series of microsurgical free flap reconstructions to amputation stumps of the upper as well as the lower extremities was reviewed in 7 male and 2 female patients. Indications included preservation of length after trauma in 6 patients and cure of local infection in 2 patients. In 1 patient an extensive defect after resection of a recurrent shoulder sarcoma required use of a complete arm fillet free flap for tumor reconstruction. Microvascular free flaps used included four scapular flaps, two fillet flaps from the amputated extremity, one anterolateral thigh flap, and one lateral arm flap. Seven of 9 patients were fitted with a prosthesis and underwent occupational therapy resulting in ambulatory and improved functional status. Microvascular reconstruction is indicated in emergency settings as well as for elective reconstruction of amputation sites. Using uninjured "spare parts" of the amputated extremity should be considered. Elective reconstruction is performed preferably with free flaps based on the subscapular vascular system.

Adolescent↗
PubMed1976

Painful pigmented prosthesis pressure papules.

Two patients who presented with tender hyperkeratotic papules involving their weight-bear.ing amputation stumps were studied. Although these clinical findings are common in the experience of prosthetists, the author has been unable to find any documentation of these findings in the literature. All attempts at relining and reshaping the cups of the original offending prostheses by experienced prosthetists were unsuccessful. The eruption cleared only after entirely new prostheses were designed. It would appear that this condition is due to a poorly fitting prosthesis.

Adult↗
PubMed1991

Continuous postoperative regional analgesia by nerve sheath block for amputation surgery--a pilot study.

A pilot study of continuous postoperative regional analgesia by nerve sheath block for lower limb amputation is presented. At the time of exposure of sciatic or posterior tibial nerve trunks during above- or below-knee amputations in 11 patients with ASA physical status III or IV, a catheter was introduced directly into the transected nerve sheath for continuous infusion of 0.25% bupivacaine at a rate of 10 mL/h for 72 h. Effective amputation stump analgesia was obtained, significantly reducing the need for on-demand narcotic analgesics during this time to a mean dose equivalent of 1.4 mg of morphine compared with a retrospective control group who received the equivalent of a mean dose of 18.4 mg of morphine (P less than 0.0001). No complications related to the technique were observed. A follow-up of the group receiving continuous postoperative regional analgesia for up to 12 mo showed a total absence of phantom pain despite the presence of preoperative limb pain.

Aged↗
PubMed1996

Aesthetic refinements in toe-to-hand transfer surgery.

Techniques for aesthetic refinement are as important as those for functional improvement in toe-to-hand transfer. The appearance of the thumb reconstructed using various types of great toe transfer can be improved by reduction of the soft tissue, bone, interphalangeal joint, and nail and by secondary pulp reduction and contouring procedures. Finger and thumb reconstructions using lesser toes can be improved aesthetically by minimal inclusion of adipofibrous tissue under the plantar skin flap especially at the metatarsophalangeal joint region, thus decreasing the anterior-posterior bulkiness. Tight extensor repair, temporary K-pin fixation of the proximal and distal interphalangeal joint in extension, followed by prolonged use of a nighttime extension splint and secondary pulp reduction help to avoid the claw and drumstick appearances of the transferred lesser toe. Adequate soft-tissue coverage, cruciate skin incisions, extensive mobilization, and thinning and trimming of the skin flaps of the digital amputation stump lead to a smooth junction between the amputated digit and the transferred toe. In the distal digital reconstruction, skeletonization of medial and lateral neurovascular bundles of the harvested toe helps primary closure of the digital wound, thus avoiding the unsightly skin graft on the sides of the reconstructed digit. Regarding the donor foot, preservation of the proximal 0.5 to 1 cm of the proximal phalangeal stump of the great toe maintains the span of the foot, thus improving donor site appearance. In single lesser toe or combined second and third toe transfer, the proximal phalanx should not be preserved but an optimal web space should be reconstructed. Primary closure without skin graft is essential for aesthetic appearance of the donor foot.

Amputation, Traumatic↗
PubMed1998

Preexpansion of the tensor fasciae latae for free-flap transfer.

Preexpansion has become an established technique to prefabricate elective free flap transfers. We report the use of the tensor fasciae latae flap as a donor site in two cases for reconstruction of a burn scar neck contracture and an unstable contralateral below-knee amputation stump, of which other donor sites were ruled out either by the patients' condition or by choice. Implantation and transfer were straightforward and the donor sites of very large flaps were minimized by preexpansion. The preexpanded muscle fasciocutaneous flaps were transplanted with microsurgical anastomoses of the vessels. Apart from a small area of necrosis at the distal tip of the flap developing on the sixth postoperative day, which we excised in a second operation, there were no major complications. The advantages of the combination of preexpansion and free flap transfer as well as the unique anatomical and functional qualities of this musculocutaneous unit are emphasized.

Adult↗
PubMed1996

Femur lengthening with a vascularized tibia bone flap.

A vascularized tibial bone flap based on a single nutrient vessel has been previously proposed for use in long-bone reconstruction. While the routine use of the tibia for donor bone tissue is precluded by its essential weight-bearing function, in select cases it provides a useful alternative to standard donor bone sources. Cadaver dissection was performed to confirm the endosteal and periosteal vascular anatomy of the tibia. The presence of a consistent nutrient vessel was confirmed. Selective dye injection demonstrated a dual cortical blood supply based on both the endosteal nutrient vessel and multiple periosteal perforator vessels. Inclusion of both vascular supplies maximizes perfusion of bone and periosteum, thus potentially optimizing bone healing and osseous union. Based on these findings, the vascularized tibial bone flap was applied to a clinical case. A 45-year-old male veteran sustained a right proximal femur fracture in a motor vehicle accident. Multiple attempts at fusion with open reduction, internal fixation, grafting, and nonvascularized fibular onlay strut with cerclage wires were all unsuccessful. The patient presented with a chronic right femur nonunion with painful pseudoarthrosis; frozen knee joint; and an internally rotated, 20.3-cm shortened, nonfunctional lower limb. Femur length proximal to the nonunion was less than 15 cm. A maximum amputation stump length is recommended for optimal prosthetic function. A 15-cm pedicled tibial bone flap based on the posterior tibial endosteal and periosteal vascular supply was reversed and plated to the proximal femur to provide a stump of adequate length to optimize prosthetic fitting and function. The tibia is essential for normal weight-bearing, but in select cases may be sacrificed for use in long-bone reconstruction. Expanded use of tibial vascularized allografts in long-bone reconstruction may be made possible following future development of effective and safe immunosuppressive therapy. Transfer based on the posterior tibial pedicle, which includes the endosteal nutrient vessel as well as the periosteal supply via the tibialis posterior muscle, maximizes bone perfusion. The pedicle is of sufficient length to be used for positioning the tibia in the thigh or for free transfer to distant sites.

Amputation Stumps↗
PubMed1989

[Immunomapping in localized bullous pemphigoid].

A 70-year-old Caucasian patient is described, who presented with a bullous dermatosis on an amputation stump. The bullous lesions had developed after practice with a Kondylen-Bettung-Münster (KBM) prosthesis. The lesions disappeared completely after prednisone therapy and replacement of the prosthesis with a Thomas splint. The patient has remained free of symptoms ever since, even though prednisone was completely withdrawn after 9 months. According to skin immunofluorescence criteria, the patient suffered from pemphigoid, rather than epidermolysis bullosa acquisita as strongly suggested by the anamnesis. In particular, the presence of linear IgG at the level of the lamina lucida of the epidermal basement membrane zone and the localization of laminin antigen at the blister floor are highly suggestive of pemphigoid.

Aged↗
PubMed1997

A case of contact dermatitis due to impurities of cetyl alcohol.

A 29-year-old man being treated for itchy lesions on the amputation stump of the thigh became allergic to betamethasone valerate and gentamicin sulfate cream (Rinderon VG). Closed patch tests with all the ingredients of the cream revealed positive reactions to cetyl alcohol 30% to 5% pet. Gas chromatographic analysis of the cetyl alcohol in the cream base detected stearyl alcohol (C18), myristyl alcohol (C14) and lauryl alcohol (C12) in addition to the main component of cetyl alcohol (C16). Patch testing with 99% pure analytical reagent grade saturated alcohols (C10, C11, C12, C13, C14, C15, C16, C17, C18, C19, C20) showed negative reactions. Thus, it is concluded that some minor impurities in cetyl alcohol not detected by gas chromatography might be the cause of this dermatitis.

Adult↗
PubMed1988

Persistent pain after excision of an interdigital neuroma. Results of reoperation.

Thirty-four patients (thirty-seven feet) had a reoperation for pain that persisted after excision of a plantar interdigital (Morton) neuroma. A longitudinal plantar incision was used in thirty-three feet and the previous dorsal web-space incision was used in four feet. Of the thirty-nine pathological specimens that were obtained intraoperatively, twenty-six (67 per cent) contained elements either of primary interdigital neuroma tissue or of an interdigital neuroma in association with an amputation-stump neuroma, indicating that the recurrent pain in these patients had probably resulted from an incomplete initial excision. All but one of the thirty-four patients were available for follow-up at an average of seventy-six months (range, ten to 124 months) postoperatively. Twenty-two patients (67 per cent) had complete relief from or marked improvement in pain, three (9 per cent) had improvement but had persistent pain, and eight (24 per cent) had no improvement or had worse pain. The longitudinal plantar incision was satisfactory in all but one patient and did not result in a painful plantar scar. The number of previously unsuccessful attempts that had been made to excise the neuroma did not adversely affect the results of reoperation in this group of patients.

Adult↗
PubMed1984

Response of amputated rat limbs to fetal nerve tissue implants and direct current.

We have previously shown that implanted fetal nerve tissue stimulates the regeneration of amputated chick limbs. The purpose of this study was to determine whether a similar phenomenon would occur in amputated rat limbs and if addition of applied direct current (DC) would affect this process. Thus, fetal nerve tissue was implanted into amputated stumps of 3-week-old rats; variable tissue regeneration was induced that was dependent on the age of the donor implant and the presence of applied DC. Twelve or 14 day fetal neural implants induced new accessory bones containing epiphyseal plates and marrow cavities and occasionally formed joint-like structures with the host humerus. Addition of DC to 12 day neural implants increased the number of new bones formed. Eighteen day neural tissue with applied DC did not induce new bone formation but stimulated the maximal elongation of the host humerus and outgrowth of nerve fibers to the cut surface. Implantation of fetal heart tissue or implantation of fetal neural tissue into unamputated limbs failed to induce new bone formation. Although true limb regeneration was not achieved, formation of new skeletal elements did occur and this effect was enhanced by applied DC.

Amputation Stumps↗
PubMed1996

Completion arteriography in paramalleolar bypasses: effect of configurational changes, with special reference to spasm, on long-term outcome.

PURPOSE: The purpose of this study was to ascertain the durability of paramalleolar bypasses and elucidate the effect of configurational changes, especially spasm, seen on the completion arteriography upon the outcome. DESIGN: Retrospective study. SETTING: University hospital experience. PATIENTS AND METHODS: Nineteen paramalleolar bypass operations in sixteen patients performed between April 1988 and March 1995 were studied retrospectively. Reversed saphenous vein grafts were used in all cases. One patient required an additional microvascular free flap transfer to cover a foot amputation stump. Seventeen completion arteriograms were obtained. Patients were followed for an average of 37 months. RESULTS: One patient died in hospital, giving a hospital death rate of 5.9%. Two grafts failed immediately and could not be salvaged. Inadvertent perforation of one graft required partial replacement with a polytetrafluoroethylene graft; it eventually failed after 42 months. There were no other graft failures during follow-up. Nine completion arteriograms showed spastic change of the run-off artery, but this change had disappeared on repeat angiograms obtained before discharge. CONCLUSION: Spasm of run-off artery is a frequent finding in distal bypass surgery and adversely affects the immediate outcome. Heparinization during the first 24 hours after surgery may reduce the consequences of spasm, and long-term patency can be expected providing that the whole graft consists of autogenous vein.

Adult↗
PubMed1999

[Below-knee amputation according to Robb-Persson. Technique and clinical results].

The successful rehabilitation and the quality of life of below-knee amputees depend to a great extent on the load-bearing capacity of the amputation stump. Robb and Persson's operating method, utilizing a sagittal cut was used in 154 be low-knee amputations in the period 1982-1992 that were retrospectively analysed. In 91% of the cases, advanced vascular disorders related to diabetes mellitus were the main cause for the loss of a limb. Postoperative mortality amounted to 31.8%, the re-amputation rate was 4.5%. Rehabilitation up to full walking capability was achieved by 75% of the surviving patients. 46 patients were re-examined between 1 and 6 years after amputation. In 85% of the cases the condition of the stump was found to be good to very good. The functional rehabilitation results are comparable to those of other operating methods. The advantages of the Robb-Persson below-knee amputation method are the simplicity of the technique and a secure and longlasting effective stump cover, resulting in favourable long-term results.

Adult↗