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Surgical revision for stump problems after traumatic above-ankle amputations of the lower extremity.

Liu K, Tang T, Wang A, Cui S - BMC Musculoskelet Disord (2015)

Bottom Line: A total of 80 stumps were treated surgically.The frequency of excess soft tissue in above-knee amputation cases was higher than that in below-knee amputation (p = 0.007).There was a significant difference in the ADL scores between admission and discharge (p = 0.000).

View Article: PubMed Central - PubMed

Affiliation: School of Rehabilitation Medicine, Capital Medical University, Beijing, China. keminlqliu@sina.com.

ABSTRACT

Background: Stump problems (SPs) secondary to traumatic lower limb amputation had a crucial influence on amputees' ability to return to living and work. The purpose of this study was to investigate the surgical management strategies of the SPs after above-ankle amputation of the lower limb secondary to trauma.

Method: A cohort of clinical cases, who were troubled by SPs after above-ankle amputation following trauma, had undergone revision surgery of the stump and was analyzed retrospectively. Various factors were noted like sex, unilateral or bilateral, amputation type, and causes of trauma. Different SPs like excess soft tissue (where a considerable amount of soft tissue interposed between the rigid elements which hindered the fitting of a prosthesis), scar, ulcers, neuromas, and bone spurs were taken as dependent variables. The relationship between factors and SPs was analyzed.

Results: A total of 80 stumps were treated surgically. The frequency of excess soft tissue in above-knee amputation cases was higher than that in below-knee amputation (p = 0.007). Bone spur occurred more frequently in the unilateral amputation than in bilateral ones (p = 0.018). There was a significant difference in the ADL scores between admission and discharge (p = 0.000).

Conclusion: Stump problems secondary to traumatic lower limb amputation had crucial influence on amputees' ability to return to living and work, appropriate evaluation and timely surgical revision showed excellent results.

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Related in: MedlinePlus

Excess soft tissue and scars of the stump affected prosthetic wearing and weight-bearing (a); the shape of residual limb was improved significantly after stump revision (b).
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Fig1: Excess soft tissue and scars of the stump affected prosthetic wearing and weight-bearing (a); the shape of residual limb was improved significantly after stump revision (b).

Mentions: The surgical procedures were performed under continuous epidural anesthesia with tourniquets. Plastic surgery was done when the soft tissue coverage was poor, including for excess soft tissue (Figure 1) or obvious scars and ulcers (Figures 2a and 3a). If the defect in the soft tissue was assessed to be too large to be covered by surrounding healthy skin after excision, then the patients or his family members were asked to assist with the manipulation procedures of pushing and pulling the scar and surrounding healthy skin, or water balloon dilators were implanted under the healthy skin surrounding the scar to dilate the skin. Surgery was not carried out until the laxity of the surrounding healthy skin was identified to be adequate to cover the defect. Stamp skin grafting was avoided because of its poor wear resistance, which might cause skin rupture when the prosthesis was installed. If stump pain was determined to be caused by the bone spur or neuroma, surgical resection (Figures 2b and 3b) was then performed. The surgical resection of a neuroma was achieved by sharp dissection and nerve end ligation, followed by embedding the nerve end with epineurium. The stump bone spur was removed under direct vision, and the bone end was rasped to a round, smooth contour (Figure 2b). If the stump was identified to be conical, either myodesis or myoplasty was performed, and the bone was adequately shortened to create cylindrical or cylindrical-like residual limbs (Figure 3c).Figure 1


Surgical revision for stump problems after traumatic above-ankle amputations of the lower extremity.

Liu K, Tang T, Wang A, Cui S - BMC Musculoskelet Disord (2015)

Excess soft tissue and scars of the stump affected prosthetic wearing and weight-bearing (a); the shape of residual limb was improved significantly after stump revision (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4352282&req=5

Fig1: Excess soft tissue and scars of the stump affected prosthetic wearing and weight-bearing (a); the shape of residual limb was improved significantly after stump revision (b).
Mentions: The surgical procedures were performed under continuous epidural anesthesia with tourniquets. Plastic surgery was done when the soft tissue coverage was poor, including for excess soft tissue (Figure 1) or obvious scars and ulcers (Figures 2a and 3a). If the defect in the soft tissue was assessed to be too large to be covered by surrounding healthy skin after excision, then the patients or his family members were asked to assist with the manipulation procedures of pushing and pulling the scar and surrounding healthy skin, or water balloon dilators were implanted under the healthy skin surrounding the scar to dilate the skin. Surgery was not carried out until the laxity of the surrounding healthy skin was identified to be adequate to cover the defect. Stamp skin grafting was avoided because of its poor wear resistance, which might cause skin rupture when the prosthesis was installed. If stump pain was determined to be caused by the bone spur or neuroma, surgical resection (Figures 2b and 3b) was then performed. The surgical resection of a neuroma was achieved by sharp dissection and nerve end ligation, followed by embedding the nerve end with epineurium. The stump bone spur was removed under direct vision, and the bone end was rasped to a round, smooth contour (Figure 2b). If the stump was identified to be conical, either myodesis or myoplasty was performed, and the bone was adequately shortened to create cylindrical or cylindrical-like residual limbs (Figure 3c).Figure 1

Bottom Line: A total of 80 stumps were treated surgically.The frequency of excess soft tissue in above-knee amputation cases was higher than that in below-knee amputation (p = 0.007).There was a significant difference in the ADL scores between admission and discharge (p = 0.000).

View Article: PubMed Central - PubMed

Affiliation: School of Rehabilitation Medicine, Capital Medical University, Beijing, China. keminlqliu@sina.com.

ABSTRACT

Background: Stump problems (SPs) secondary to traumatic lower limb amputation had a crucial influence on amputees' ability to return to living and work. The purpose of this study was to investigate the surgical management strategies of the SPs after above-ankle amputation of the lower limb secondary to trauma.

Method: A cohort of clinical cases, who were troubled by SPs after above-ankle amputation following trauma, had undergone revision surgery of the stump and was analyzed retrospectively. Various factors were noted like sex, unilateral or bilateral, amputation type, and causes of trauma. Different SPs like excess soft tissue (where a considerable amount of soft tissue interposed between the rigid elements which hindered the fitting of a prosthesis), scar, ulcers, neuromas, and bone spurs were taken as dependent variables. The relationship between factors and SPs was analyzed.

Results: A total of 80 stumps were treated surgically. The frequency of excess soft tissue in above-knee amputation cases was higher than that in below-knee amputation (p = 0.007). Bone spur occurred more frequently in the unilateral amputation than in bilateral ones (p = 0.018). There was a significant difference in the ADL scores between admission and discharge (p = 0.000).

Conclusion: Stump problems secondary to traumatic lower limb amputation had crucial influence on amputees' ability to return to living and work, appropriate evaluation and timely surgical revision showed excellent results.

Show MeSH
Related in: MedlinePlus