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A prospective study of lower limb amputations.

G G Barber, N V McPhail, T K Scobie

    Canadian Journal of Surgery. Journal Canadien De Chirurgie
    |July 1, 1983
    PubMed
    Summary

    Below-knee amputations offer better outcomes for vascular disease patients compared to above-knee procedures. Striving for below-knee amputation with rigid dressings improves healing and ambulation, reducing mortality and reamputation rates.

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    Area of Science:

    • Vascular Surgery
    • Orthopedic Surgery
    • Rehabilitation Medicine

    Background:

    • Vascular disease is the primary indication for leg amputations.
    • Amputation outcomes vary significantly based on the level of limb loss and dressing technique.

    Purpose of the Study:

    • To compare the outcomes of different leg amputation levels (above-knee, below-knee, transmetatarsal, digital).
    • To evaluate the impact of rigid versus soft dressings on below-knee amputation healing.
    • To assess mortality, healing rates, prosthesis use, and ambulation for various amputation levels.

    Main Methods:

    • Retrospective analysis of patients undergoing leg amputations for vascular disease.
    • Categorization of amputations by level: above-knee, below-knee, transmetatarsal, and digital.

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  • Comparison of outcomes including healing rates, reamputation, mortality, prosthesis use, and functional status.

    • Main Results:

    • Above-knee amputations had a 30% mortality rate, with only 10% prosthesis use and 48% requiring bed care.
    • Below-knee amputations showed a 7.2% mortality rate, 15% reamputation rate, and 57% full ambulation with prosthesis.
    • Transmetatarsal and digital amputations had 80% healing but an 11% mortality rate.

    Conclusions:

    • Below-knee amputation is preferred for patients eligible for rehabilitation, aiming for optimal healing and ambulation.
    • Rigid dressings are recommended for below-knee amputations to potentially improve healing outcomes.
    • Clinical judgment remains crucial in determining the most appropriate amputation level for individual patient rehabilitation.