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Lower limb amputation and grade of surgeon
S A White1, M M Thompson, A M Zickerman
1Department of Surgery, Leicester Royal Infirmary, UK.
The British Journal of Surgery
|April 1, 1997
Summary
Independent ambulation after major limb amputation is low (26%). Amputation performed by a junior trainee was associated with poorer prosthetic limb walking outcomes. Senior surgeon involvement may improve patient mobility.
Area of Science:
- Orthopedics
- Vascular Surgery
- Rehabilitation Medicine
Background:
- Major limb amputation is often necessary for peripheral vascular disease.
- Identifying factors influencing post-amputation ambulation is crucial for patient outcomes.
Purpose of the Study:
- To identify clinical and operative risk factors affecting independent ambulation after lower limb amputation.
- To evaluate the impact of surgeon experience on prosthetic limb use.
Main Methods:
- Retrospective analysis of 193 lower limb amputations in 172 patients (1989-1993) for peripheral vascular disease.
- Data collected on amputation level, patient comorbidities, and surgical factors.
- Statistical analysis to determine risk factors for independent ambulation.
Main Results:
- Overall independent ambulation rate was 26% post-rehabilitation and limb-fitting.
- Amputation revision rate was 13.5%, higher with prior vascular reconstruction.
- Independent ambulation was not significantly affected by age, comorbidities, or amputation level.
- Fewer patients ambulated independently when amputation was performed by a junior trainee (P=0.03).
Conclusions:
- Surgeon experience is a significant factor in optimizing prosthetic limb ambulation.
- Amputations for walking training should ideally be performed by senior trainees or consultants.
- Further research into optimizing ambulation outcomes after major limb amputation is warranted.