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Related Experiment Videos

Lower limb amputation: striking the balance

W B Campbell, J A St Johnston, V F Kernick

    Annals of the Royal College of Surgeons of England
    |May 1, 1994
    PubMed
    Summary

    Elderly patients undergoing amputation for peripheral arterial disease often require revisions, with limited prosthetic use impacting mobility. This study highlights challenges in amputation surgery and rehabilitation for this demographic.

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    Area of Science:

    • Vascular Surgery
    • Amputation Surgery
    • Rehabilitation Medicine

    Background:

    • Peripheral arterial disease (PAD) frequently necessitates lower limb amputation in elderly patients.
    • Previous attempts at limb salvage, such as arterial bypass grafting, can influence amputation outcomes.
    • Optimizing amputation level and prosthetic rehabilitation is crucial for functional recovery in this population.

    Purpose of the Study:

    • To evaluate amputation levels, revision rates, and mortality in patients with PAD.
    • To assess the impact of prior arterial bypass surgery on amputation outcomes.
    • To determine the functional mobility achieved with prosthetic use in elderly amputees.

    Main Methods:

    • Retrospective review of 210 patients undergoing 228 primary amputations for PAD over 5 years.
    • Analysis of amputation levels (below-knee, above-knee, Gritti-Stokes), revision rates, and 30-day mortality.
    • Follow-up of 69 patients fitted with prosthetics to assess mobility outcomes.

    Main Results:

    • Below-knee amputations were most common (65%), with an overall revision rate of 19% and 30-day mortality of 14%.
    • Patients with prior bypass grafting showed similar revision rates (13%) compared to those without.
    • While 81% used prosthetics for household mobility, only 16% achieved near-normal mobility.

    Conclusions:

    • Failed arterial bypass surgery did not appear to negatively impact amputation level or healing.
    • High revision rates and low rates of significant prosthetic use persist in elderly PAD amputees.
    • Current strategies for below-knee amputation and rehabilitation show limited success in restoring high-level function.

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