RESUMEN
There is little written about the value of revision surgery on lower-limb amputations. We report on 71 revision amputation procedures performed by a single surgeon in this retrospective analysis. The majority of our revisions (61%) were in amputees who had suffered trauma. We judged success from a surgical and a rehabilitation perspective using scoring systems. Revisions for bony and soft-tissue pathology had good outcomes from a surgical (85% and 82%) and a rehabilitation perspective. Revisions for infection had satisfactory results from a surgical perspective (73%) but less so from a rehabilitation perspective (25%). The results of the revisions for pain were poor showing surgical success only 50% of the time where a neuroma was suspected and only 25% when there was no apparent cause. There was little or no improvement in rehabilitation in both the pain groups. Revision surgery for certain pathologies gives a good surgical outcome and can improve pain and mobility status. Patient selection for surgery is key and evaluation by a multidisciplinary team is recommended.
Asunto(s)
Amputación Quirúrgica/rehabilitación , Extremidad Inferior/cirugía , Dolor Postoperatorio/rehabilitación , Procedimientos Innecesarios/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/estadística & datos numéricos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Reoperación/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Reino Unido , Adulto JovenRESUMEN
Osseointegration for the trans-femoral amputee has been used in the United Kingdom since 1997. To date, 11 candidates have undergone the procedure. The rehabilitation programme for the osseointegration candidate is a long and intensive programme following two surgical operations. This paper outlines the importance of a pre-osseointegration assessment to explore candidates' suitability and expectations for the procedure. The physical and prosthetic advantages of direct skeletal attachment have led to improvements in candidates' comfort, function and quality of life. However, some aspects of this promising developmental procedure for the management of the trans-femoral amputee need to be critically evaluated before it becomes a routine clinical procedure in the United Kingdom.
Asunto(s)
Amputados/rehabilitación , Oseointegración/fisiología , Péptidos/fisiología , Diseño de Prótesis , Amputación Quirúrgica/métodos , Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Fenómenos Biomecánicos , Femenino , Fémur/cirugía , Humanos , Masculino , Selección de Paciente , Polímeros , Ajuste de Prótesis , Sensibilidad y Especificidad , Estrés Mecánico , Reino UnidoRESUMEN
1. Two complimentary techniques were used to study cortical function in six human upper limb amputees: positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF) were made in subjects during limb movements to study activation of the primary motor (M1), primary somatosensory (S1), and association cortices; and electromyographic responses to transcranial magnetic stimulation (TMS) were measured in proximal upper limb muscles to assess the excitability of corticospinal neurons in subjects at rest. 2. To explore possible cortical mechanisms governing the phantom limb phenomenon, PET and TMS findings were compared between subjects with acquired, traumatic upper limb amputations (n = 3), in whom phantom limb symptoms were prominent, and congenital upper limb amputees (n = 3) without phantom limbs. 3. Paced shoulder movements were associated with significant blood flow increases in the contralateral M1/S1 cortex of both groups of amputees. In traumatic amputees, these increases were present over a wider area and were of significantly greater magnitude in the partially deafferented cortex contralateral to the amputation. In congenital amputees blood flow increases were also present over a wider area in the partially deafferented M1/S1 cortex, but their magnitude was not significantly different from that in the normally afferented M1/S1 cortex. 4. Abnormal blood flow increases also were present in the partially deafferented M1/S1 cortex of traumatic amputees during movement of the ipsilateral, intact arm. Abnormal ipsilateral M1/S1 responses were not present during movement of the intact arm in the congenital group. 5. TMS studies showed that the abnormal blood flow increases in the partially deafferented M1 cortex of traumatic amputees were associated with increased corticospinal excitability.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Amputación Quirúrgica , Brazo/inervación , Corteza Cerebral/irrigación sanguínea , Campos Electromagnéticos , Regeneración Nerviosa/fisiología , Plasticidad Neuronal/fisiología , Miembro Fantasma/fisiopatología , Tomografía Computarizada de Emisión , Adulto , Vías Aferentes/irrigación sanguínea , Vías Aferentes/diagnóstico por imagen , Velocidad del Flujo Sanguíneo/fisiología , Mapeo Encefálico , Corteza Cerebral/diagnóstico por imagen , Ectromelia/diagnóstico por imagen , Ectromelia/fisiopatología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Corteza Motora/irrigación sanguínea , Corteza Motora/diagnóstico por imagen , Inhibición Neural/fisiología , Lóbulo Parietal/irrigación sanguínea , Lóbulo Parietal/diagnóstico por imagen , Miembro Fantasma/diagnóstico por imagen , Flujo Sanguíneo Regional/fisiología , Corteza Somatosensorial/irrigación sanguínea , Corteza Somatosensorial/diagnóstico por imagen , Transmisión SinápticaRESUMEN
The Klippel-Trenaunay Syndrome is a triad of congenital anomalies characterized by a vascular naevus, varicose veins and hypertrophy of soft tissue and bone. A number of patients affected with this rare syndrome need amputation. In this paper the systemic problems, stump complications and prosthetic difficulties of four amputees with Klippel-Trenaunay syndrome are outlined. The period of follow-up ranged from 10 to 24 years after amputation.