The Below-Knee Amputation: To Amputate or Palliate?

Brown, B. R.; Attinger, Christopher E.

doi:10.1089/wound.2011.0317

Cited by 17 publications

(29 citation statements)

References 33 publications

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“…Recent expert opinion has called into question this preference, 14,15 highlighting that 30%–50% of people with a PFA experience complications such as dehiscence, ulceration and wound failure. By comparison, these complications affect just 10%–20% of people with TTA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of quality of life in people with partial foot and transtibial amputation

Quigley

Dillon

Duke

2016

Prosthetics &Amp; Orthotics International

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Section: Introductionmentioning

confidence: 99%

Comparison of quality of life in people with partial foot and transtibial amputation

Quigley

Dillon

Duke

2016

Prosthetics &Amp; Orthotics International

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“…This is in contrast to findings among vascular amputees where 85% are fitted with a prosthesis after major lower limb amputation. 21 Brown and Attinger 22 in 2013 underlined the importance of rehabilitation after amputation and further emphasised that advanced technological prosthetics have led to an improved quality of life following rehabilitation among patients with LLA. These authors, however, emphasise patient selection when considering the level of limb amputation.…”

Section: Discussionmentioning

confidence: 99%

A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience

Manickum

Ramklass

Madiba

2019

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology: A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor.

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“…[7][8][9] Currently, there is no widely accepted clinical algorithm for predicting healing outcomes following minor amputation, with the level commonly determined by the judgement of the surgical team supplemented by non-invasive clinical testing to assess the vascular status of the limb. 10 Although the ankle brachial pressure index (ABPI) is widely recommended as a non-invasive test for objectively assessing lower limb vascular status, 11 it can be falsely elevated in people with diabetes due to the effects of medial arterial wall calcification. 12 Furthermore ABPI does not detect lesions distal to the ankle which can also be a characteristic of diabetes-related PAD.…”

Section: Introductionmentioning

confidence: 99%

Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? A systematic review and meta-analysis

Linton

Searle

Hawke

et al. 2020

Diabetes and Vascular Disease Research

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Purpose of study: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations. Key methods: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist. Main results: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure <30 mmHg had 2.09 times the relative risk of non-healing post amputation, compared to toe systolic blood pressure ⩾30 mmHg (relative risk = 2.09, 95% confidence interval: 1.37–3.20, p = 0.001). Two studies investigating toe-brachial pressure index report successful healing where toe-brachial pressure index >0.2, with one study reporting a higher value of 0.8. Main conclusions: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.

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The Below-Knee Amputation: To Amputate or Palliate?

Cited by 17 publications

References 33 publications

Comparison of quality of life in people with partial foot and transtibial amputation

Comparison of quality of life in people with partial foot and transtibial amputation

A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience

Do toe blood pressures predict healing after minor lower limb amputation in people with diabetes? A systematic review and meta-analysis

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