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The status of lower-limb amputation in Bangladesh: a 6-year review
M Aftabuddin1, N Islam, M A Jafar
1Department of Surgery, Mymensingh Medical College, Bangladesh.
Insights
Lower-limb amputation surgery type significantly impacts patient outcomes. Above-knee amputations had lower success rates, highlighting the need for careful surgical consideration to improve rehabilitation after limb loss.
Area of Science:
- Surgical outcomes
- Rehabilitation medicine
- Public health
Background:
- A review of 450 lower-limb amputations performed between 1982 and 1987 in Bangladesh.
- The incidence of amputation in the covered region was 0.75 per 1000 inhabitants annually.
Purpose of the Study:
- To analyze the indications, surgical levels, outcomes, and rehabilitation success rates of lower-limb amputations.
- To identify factors influencing rehabilitation success and inform surgical decision-making.
Main Methods:
- Retrospective review of patient records for single lower-limb amputations.
- Analysis of amputation indications, level of surgery (above-knee vs. below-knee), reamputation rates, operative mortality, wound healing, prosthesis use, and rehabilitation success.
Main Results:
- Limb ischemia was the primary indication (81%).
- Above-knee (AK) to below-knee (BK) amputation ratio was 1:65, with 67% ultimately requiring AK amputation.
- Operative mortality was 21%; uncomplicated primary wound healing was 89% among survivors.
- Prosthesis use was 75% among survivors, but rehabilitation success was significantly lower for AK (44%) compared to BK (86%) amputees.
Conclusions:
- The type of amputation surgery significantly impacts rehabilitation outcomes.
- Prioritizing below-knee amputations when feasible can lead to higher rates of successful rehabilitation.
- Careful surgical planning is crucial to minimize rehabilitation failure in lower-limb amputations.
Abstract:
We conducted a review of 450 single lower-limb amputations performed in our hospital in Bangladesh between July 1982 and June 1987. The incidence of amputation in the specific area of 1000000 inhabitants covered by the hospital was 0.75/10(3) per year. The indications for amputation were: limb ischemia in 366 patients (81%), traumatic crush injury in 45 (10%), diabetes-associated complications in 20 (5%), severe limb infection in 10 (2%), and neoplasm growth in 10 (2%). The ratio of above-knee (AK) to below-knee (BK) amputation was 1:65, and 36 patients (8%) required reamputation, 22 of whom had undergone BK amputation previously. Thus, the number of patients with a final amputation at AK level was 302 (67%). The operative mortality was 21% and the uncomplicated primary wound healing rate was 89% within the survivors. Among the 355 patients who survived the amputation, 265 (75%) were given a prosthesis, 50 (14%) refused a prosthesis, and the remaining 40 (11%) were unfit for a prosthesis. Rehabilitation was successful in 44% of the AK and 86% of the BK amputees. In conclusion, when amputation is inevitable, maximum consideration should be given to the type of surgery performed to avoid rehabilitation failure.
