Lower extremity amputation: The control series

Abstract

Although various techniques to determine amputation level have become available, obvious clinical factors may yet identify patients in whom a major amputation is unlikely to heal. We have analyzed the association of multiple clinical factors with the morbidity of 1028 consecutive amputations performed in 786 patients during a 13-year period. The overall operative mortality rate was 7% (57 of 786 patients). Cardiac complications were the leading cause of death (43%). In the 729 patients surviving operation, 345 above-knee amputations (AKAs) and 626 below-knee amputations (BKAs) were performed. After operation, 15.4% of these amputations failed to heal and required proximal revision. The AKA failure rate was 9% and the BKA failure rate was 19%. Significantly higher failure rates were noted in whites, nondiabetics, and those patients with heart disease. It is concluded that major amputation continues to be associated with significant morbidity and mortality rates despite changes in perioperative care and surgical technique. Common clinical characteristics indicate high-risk patients in whom a BKA is unlikely to heal and who may benefit from prospective attempts to determine amputation level.

Chronic kidney disease predicts long-term mortality after major lower extremity amputation

“…We report a rate of wound revision and conversion that is lower than the rates reported in larger series where wound revision ranged between 13.2% and 15.4% and conversion ranged between 9% and 20%. [162728] Also, we did not find a higher rate of local wound complications in the BKA group compared to the AKA group, which is different from previous reports. [2229] The lower rate of local wound complications could be explained by the relatively high rate of staged procedures in our series (40%), since 46% of the procedures were performed in the setting of limb-threatening wet gangrene; two-stage amputation has fewer wound complications than one-stage amputation performed for wet gangrene.…”

Through-knee amputation in patients with peripheral arterial disease: A review of 50 cases

“…A similar rationale is used to justify performing BKA in patients who are candidates for rehabilitation despite a 20% incidence of wound complications reported for BKA. 28 We have not encountered late wound complications. The shape of the stump distributes the weight over the entire surface of the stump rather than over the condyles as with the standard TKAmp prosthesis.…”

Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

“…As people live longer, the complications of diabetes, peripheral vascular disease, and other chronic diseases progressively increase the frequency of lower limb loss. Since these disease states are systemic, previous studies (Bodily and Burgess 1983;Ebskov and Josephsen 1980;Keragy et al 1986) have shown that approximately 33 -50% of surviving patients can be expected to lose their second limb within the 2 -3 years following the first amputation. The number of bilateral lower limb amputees has also increased as a result of trauma and congenital limb deficiencies (Bowker and Michael 1992).…”