A Study of Ambulatory Function and Complications in Adult Below Knee Amputees

Yıl 2016, , 166 - 175, 01.10.2016

Amit Saraf

https://doi.org/10.5455/umj.20161215092130

Öz

Introduction: Inspite of development of new surgical techniques amputation has many complications. These complications may further be categorized into early and delayed complications. Amputation not only causes a physical disability to the patient, it also has an effect on his social economic and psychological conditions. We undertook the present study with an aim of assessing complications and ambulatory functions in below knee amputees. Methods: 10 years study was done including a total of 174 patients. Patients were grouped into diabetics and non-diabetics based on the primary cause of amputation. Various complications which were assessed included hematoma formation, wound healing problems, infections, phantom limb/pain, contractures, etc. Ambulatory functions were assessed before surgery and at follow-ups using modified ambulatory scale by Pinzur et al 1983. Results: 41 28.5% had edema of the stump. Of these patients 26 were in diabetes group. In 38 patients stump healing was prolonged with 21 patients in diabetes group and 17 patients in the non-diabetic group. 16 patients had wound dehiscence with 11 patients in diabetic group and 5 in non diabetic group. 15 10.4% patients developed contractures after below knee amputation, of which, 9 patients were in diabetic group and 6 were in non-diabetic group. In diabetes group, preoperatively 29 46% patients had grade 6 level of ambulation. In non-diabetics preoperative grade 6 was observed in 77 95.1% of patients. Post operatively 19 30.2% patients in diabetic group and 64 79 % patients in the non-diabetic group had grade 6 ambulatory scale. 35 in diabetic group and 44 in non diabetic group lost/ changed their job. 33 patients 78.6% in diabetes group and 48 62.3% in the non-diabetic group suffered an income loss. 34 28.6% had a psychological effect following below knee amputation. Of these 34, 10 patients were in the diabetic group and 24 were in the non-diabetic group. Discussion: Haematoma formation is not significant but diabetics have a higher incidence of it in comparison to non-diabetics. Edema develops in less than one-third of the patients. Diabetics have a higher incidence of it. More than one-fifth of BK stumps gets infected, with diabetic preponderance. Wound dehiscence is common in BK amputation performed due to diabetes. There is a higher incidence of above-knee amputation after BK amputation in diabetics. Preoperative and postoperative ambulatory grade is poorer in diabetics in comparison to trauma patients. Diabetics require additional support besides using the prosthesis. Manual labor class is worst affected due to loss of job. People employed in clerical/ desk jobs have minor changes. Younger people have psychological impact commonly. The death rate is significant within one year of BK amputation and diabetics have a higher probability.

Anahtar Kelimeler

Ambulatory function, complications below knee amputees

Kaynakça

• Tooms RE. General principles of Amputation: Campbell’s Operative Orthopaedics Eighth edition: Editor AH Crenshaw: Mosby, Missouri USA: 1996:677-689
• Potts JR, Elkins RC, Peyton MD. Lower extremity amputation: review of 110 cases: Am J Surgery: 1979: 138: 924-928
• Bojunga et al. History of surgical instruments: Instruments and development of amputation technique exemplified by amputation sets from the middle of 19th century: Zentralbl Chir:1998:123:11:1309-16
• Newton CMC III. Complications of amputation surgery: Complications of orthopaedics surgery: Second edition: Editor Epps CH: JB Lippincott company, Philadelphia, USA: 1986: 2: 1335-1367
• Dijkshtra T, Reesink JK, Verdouw BC, Vanderpol WS, Feberwee T, Vulto AG. Spinal anaesthesia with articaine 5% vs bupivacaine 0.5% for day-case lower limb surgery: a double-blind randomized clinical trial: Br J Anaesth: 2008 Jan: 100(1):104
• Mark EH. Limb Deficiency and Prosthetic Management
• Archeives of Physical, medicine and rehabilitation: 2006: 87:3:15-20
• Varma SK, Lal SK, Mukherjee A. A study of phantom experience in amputees. Indian J Med Sciences: 1972: 26: 3: 185-188
• Thompson RG. Complications of lower extremity amputations: OCNA: 1972: 3: 2: 323-338
• Malone JM. Therapeutic and economic impact of a modern amputation program: Annals of Surgery: 1979: 189: 6: 798-802
• Srivastava S, Trivedi JK, Mall CP, Mishra US, Dalal PK. Psychological aspects of Amputation: Indian J Psychiatry: 1997: 39: 247-250
• Mc Whinnie DL, Gordon AC, Gray DWR, Morrison JD. Rehabilitation outcome 5 years after 1000 lower Limb amputations. Br J surg. 1994: 81: 1596-1599
• Pinzur MS, Larsen J, Smith D. Functional outcome of below knee amputation in peripheral vascular insufficiency. Clin Orthop Relat Res: 1993: 286: 247- 249
• Hoover RM. Problems and complications of amputees: Clin Orthop Relat Res: 1964 : 37 : 47
• Jonathan B. Complications of lower extremity amputations: Complications of vascular surgery: 2nd edition: Editor Larry H Hollier: Marcel Dekker, New York: 2006: 483-484
• Vinsent SK, George HW. An analysis of risk factors associated with below knee amputations: World J Surgery: 2006:30:6:1081-1087
• Thomas L, Mcallister F. Complications following lower extremity amputation:Surg Gynecol Obstet: 1965: 301-304
• Miller AE, Buskirck VA, Verhoek OW: Diabetes related lower limb amputation in New Jersey: J Med Soc NJ : 1985: 82: 723-726
• Larrson J, Agardh CD, Apelqvist J, Stenstrom A. Long term prognosisafter healed amputationin patients with diabetes: Clin Orthop Relat Res: 1998: 350: 149-158
• Chauhan A, Sham EK. Treatment of painful end-neuroma in major amputations stump: The Royal Australasian College of Surgeons 77th Annual Scientific Congress: 2008
• Delblanco TL, Thompson RG. Complications of lower extremity amputation: OCNA: 1972: 2: 323- 33
• Ninon P, Vincent M, Bonaldi K. Amputation stump neuroma: Ultrasound features: Journal of Clinical Ultra sound: 1998: 25: 2: 85-89
• Fearon J, Wheelock FC: Improved results with diabetic below knee amputations: Arch surg: 1983: 120(7): 777-80
• Chen Z, Zhang M: A report of 115 cases of amputation after electric injury: Zhonghua Shao Shang Za Zhi: 2000: 16:3:161-2
• Dormandy J, Belcher G. Prospective study of 713 below- knee amputations for ischaemia and the effect of a prostacyclin analogue on healing: Br J surgery: 2005: 81:1:33-37
• Lim TS, James M. Outcome of a contemporary amputation series: ANZ Journal of Surgery: 2006: 76: 5: 300-305
• Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study: Int Disabil Stud : 1988: 10: 61-63
• Condie ME, Jones D, Scott H, Treweek SP. A one-year national survey of patients having a lower limb amputation: Physiotherapy : 1996: 82: 14-20
• Goldberg RT. New trends in the rehabilitation of lower extremity amputees: Rehabil Lit : 1984: 45: 2-11
• Hays RM, Kraft GH. The team approach to rehabilitation: Chronic disease and Disability: 1998: 55-64
• Whyte AS, Carroll LJ. A preliminary examination of the relationship between employment, pain and disability in an amputee population: Disabil Rehabil:2002:24:9:462-470
• Heuvel S, Elisabeth T. Functional outcome after a lower limb amputation: Dissertations by University of Groningen: Editor Schoppen: 2002: 196-208