Preoperative management of the amputated limb

Lloyd, Mark; Teo, Tiew Chong; Arnstein, Peter

doi:10.1136/emj.2003.008797

Cited by 40 publications

(30 citation statements)

References 8 publications

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“…Optimum care of amputated parts is one of the factors that influence the outcome of reattachment or replantation [7,10]. None of our patients' amputated parts had optimum care.…”

Section: Discussionmentioning

confidence: 99%

Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care

Omoke

Chukwu

Madubueze

et al. 2011

International Orthopaedics (SICOT)

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Purpose We aimed to determine the epidemiological pattern and highlight challenges of managing traumatic amputation in our environment. Method This was a ten-year retrospective study of all the patients with traumatic extremity amputation seen in Ebonyi State University Teaching Hospital and Federal Medical Centre Abakaliki from January 2001 to December 2010. Result There were 53 patients with 58 amputations studied. There was a male to female ratio of 3:1 and the mean age was 32.67±1.54 years. Amputations were more prevalent in the rainy season. Road traffic accident was the predominant causative factor and accounted for about 57% of amputations. A majority of the patients (81.4%) had no prehospital care and none of the amputated parts received optimum care. Three patients underwent re-attachment of amputated fingers and one was successful. Wound infection (in 56.6% of patients) was the most common complication observed. Overall mortality was 7.5% and all were due to complications of amputations. Conclusion Appropriate injury prevention mechanisms based on the observed patterns are needed. Educational campaigns for prevention should be intensified during the rainy season and directed toward young men. Measures aimed at improving pre-hospital care of patients and optimum care of amputated parts is an important aspect to be considered in any developmental programme of replantation services in the sub-region.

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“…Optimum care of amputated parts is one of the factors that influence the outcome of reattachment or replantation [7,10]. None of our patients' amputated parts had optimum care.…”

Section: Discussionmentioning

confidence: 99%

Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care

Omoke

Chukwu

Madubueze

et al. 2011

International Orthopaedics (SICOT)

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“…The outcome of extremity transplantation may be optimized by the choice of donor [7,8] and planning of the surgical intervention [9][10][11], but the ischemia time prior to successful revascularization remains crucial, and so far is a limiting factor. Prolonged ischemia is well tolerated by bone, tendons, fat, and skin, but only poorly by muscular, vascular, and possibly neural tissues, which either undergo inhomogeneous necrosis with loss of function or are prone to succumb to compartment syndrome as a consequence of reperfusion injury [4,5].…”

Section: Introductionmentioning

confidence: 99%

Preservation of Amputated Extremities by Extracorporeal Blood Perfusion; a Feasibility Study in a Porcine Model

Constantinescu

Knall

et al. 2011

Journal of Surgical Research

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“…In order to reduce the time of ischemia, the storage and preparation of the amputated part and the reception of the patient on the arrival must be appropriately managed. Recently, Lloyd et al [21] introduced their A-M-P-U-T-A-T-E concept. This sequence emphasizes the major role of perfusion of the amputated part, its conditions of transport and its photographic documentation.…”

Section: Discussionmentioning

confidence: 99%

“…This sequence emphasizes the major role of perfusion of the amputated part, its conditions of transport and its photographic documentation. Digital pictures can be sent to the replantation unit for quick information ahead of the reception of the limb [21][22][23]. They also prevent repeated manipulation of the injured segment by all actors of the replanting chain.…”

Section: Discussionmentioning

confidence: 99%

Macroreplantations of the upper extremity: a series of 11 patients

Leclère

Mathys

Juon

et al. 2012

Arch Orthop Trauma Surg

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Introduction Micro-or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. Materials and methods Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). Results All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. Conclusion Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. Level of evidence: Level IV

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Preoperative management of the amputated limb

Cited by 40 publications

References 8 publications

Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care

Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care

Preservation of Amputated Extremities by Extracorporeal Blood Perfusion; a Feasibility Study in a Porcine Model

Macroreplantations of the upper extremity: a series of 11 patients

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