Major limb amputations: A tertiary hospital experience in northwestern Tanzania

Abstract

BackgroundMajor limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data.MethodsThis was a descriptive cross-sectional study that was conducted at Bugando Medical Centre between March 2008 and February 2010. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study. Data were collected using a pre-tested, coded questionnaire and analyzed using SPSS version 11.5 computer software.ResultsA total of 162 patients were entered into the study. Their ages ranged between 2–78 years (mean 28.30 ± 13.72 days). Males outnumbered females by a ratio of 2:1. The majority of patients (76.5%) had primary or no formal education. One hundred and twelve (69.1%) patients were unemployed. The most common indication for major limb amputation was diabetic foot complications in 41.9%, followed by trauma in 38.4% and vascular disease in 8.6% respectively. Lower limbs were involved in 86.4% of cases and upper limbs in 13.6% of cases giving a lower limb to upper limb ratio of 6.4:1 Below knee amputation was the most common procedure performed in 46.3%. There was no bilateral limb amputation. The most common additional procedures performed were wound debridement, secondary suture and skin grafting in 42.3%, 34.5% and 23.2% respectively. Two-stage operation was required in 45.4% of patients. Revision amputation rate was 29.6%. Post-operative complication rate was 33.3% and surgical site infection was the most common complication accounting for 21.0%. The mean length of hospital stay was 22.4 days and mortality rate was 16.7%.ConclusionComplications of diabetic foot ulcers and trauma resulting from road traffic crashes were the most common indications for major limb amputation in our environment. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.

The Scope of Non-Trauma Lower Limb Amputations at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

“…It is quite predictable what the quality of life will be for these disabled individuals living in a developing country. The findings of male preponderance in this study agree with finding with work done in Tanzania [1]. Other studies conducted in parts of Africa [1,10] supports the findings in this study that diseases culminating in amputation are diseases of the middle ages and the elderly.…”

“…The findings of male preponderance in this study agree with finding with work done in Tanzania [1]. Other studies conducted in parts of Africa [1,10] supports the findings in this study that diseases culminating in amputation are diseases of the middle ages and the elderly. However, a different result with a lower age range in the 3rd decade was noted in a Nigerian study [11].…”

“…The level of education of non-trauma amputees in this study also agrees well with other studies in the developing countries [1,13]. The low levels of formal education may have contributed to their lack of awareness of symptoms of disease and also placed them in a low socioeconomic bracket, hence their difficulty in accessing comprehensive health care.…”

“…The patients are also at a higher risk of surgical site infections other nosocomial infections, poor wound healing and the risk of developing cardiovascular events while on admission [17,19]. The mean length of hospital stay was however lower than in another African study that recorded an average length of stay of 22.4 days [1]. Estimates of the length of stay are important because of its financial implications as health economist and insurance schemes plan based on these values.…”

Atuação Do Enfermeiro No Referenciamento E Contrarreferenciamento De Pessoas Com Amputação

“…Existem registros com mais de 1000 anos de amputações por deformidades congênitas; traumáticas como resultado de batalhas ou acidentes; e como tratamento para algumas doenças ou complicações. Atualmente, as amputações eletivas ocorrem para evitar complicações e, por conseguinte oferecer melhores condições de vida à pessoa, especialmente quando existe dificuldade de intervenção endovascular que impossibilite a preservação do membro afetado (1)(2) .…”