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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

Leg amputation without myodesis and myoplasty, tibial end protruding under the skin (arrow), heavy scar, weight bearing pain (a); Surgical revision included osteoplasty, myodesis and scar excision was performed, a satisfactory weight-bearing surface is achieved (b).
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Fig5: Leg amputation without myodesis and myoplasty, tibial end protruding under the skin (arrow), heavy scar, weight bearing pain (a); Surgical revision included osteoplasty, myodesis and scar excision was performed, a satisfactory weight-bearing surface is achieved (b).

Mentions: In this study, issues related to soft tissue are the main cause of the stump problems (Tables 1, 2, 3 and 4), which is consistent with the report by Rotter et al. [15]. Fifty-three (66.3%) amputation limbs did not undergo myodesis in primary amputation (Figure 5a); 42 (52.5%) had excessive scar; 38 (47.5%) had a neuroma; 24 (30%) had excess soft tissues; and 14 (17.5%) had skin ulcers. Twelve stumps required revision surgery more than twice, primarily from stump pain from neuromas and bone spurs. Five patients, who felt discomfort, recurrent ulceration, or scab and callus formation after wearing their prosthesis, received re-amputation surgery for their residual limbs. Of the five cases, two had been amputated in the distal third portion of the lower leg that led to a longer stump but poor soft tissue coverage (Figure 3a); three suffered from tissue necrosis and infection due to incomplete debridement or stamp skin grafting after severe initial injuries. The standard lower leg amputation procedures were performed, and a functional stump was obtained (Figure 3b & c). Compared with the longer but poor wear-resisting leg stumps, an idea leg stumps should be pursued at the stage of primary amputation. The well wear-resisting residual limbs developed three months post-revision. The patients could wear the prosthesis with successful fitting, the walking pattern was improved obviously.Figure 5


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)

Leg amputation without myodesis and myoplasty, tibial end protruding under the skin (arrow), heavy scar, weight bearing pain (a); Surgical revision included osteoplasty, myodesis and scar excision was performed, a satisfactory weight-bearing surface is achieved (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig5: Leg amputation without myodesis and myoplasty, tibial end protruding under the skin (arrow), heavy scar, weight bearing pain (a); Surgical revision included osteoplasty, myodesis and scar excision was performed, a satisfactory weight-bearing surface is achieved (b).
Mentions: In this study, issues related to soft tissue are the main cause of the stump problems (Tables 1, 2, 3 and 4), which is consistent with the report by Rotter et al. [15]. Fifty-three (66.3%) amputation limbs did not undergo myodesis in primary amputation (Figure 5a); 42 (52.5%) had excessive scar; 38 (47.5%) had a neuroma; 24 (30%) had excess soft tissues; and 14 (17.5%) had skin ulcers. Twelve stumps required revision surgery more than twice, primarily from stump pain from neuromas and bone spurs. Five patients, who felt discomfort, recurrent ulceration, or scab and callus formation after wearing their prosthesis, received re-amputation surgery for their residual limbs. Of the five cases, two had been amputated in the distal third portion of the lower leg that led to a longer stump but poor soft tissue coverage (Figure 3a); three suffered from tissue necrosis and infection due to incomplete debridement or stamp skin grafting after severe initial injuries. The standard lower leg amputation procedures were performed, and a functional stump was obtained (Figure 3b & c). Compared with the longer but poor wear-resisting leg stumps, an idea leg stumps should be pursued at the stage of primary amputation. The well wear-resisting residual limbs developed three months post-revision. The patients could wear the prosthesis with successful fitting, the walking pattern was improved obviously.Figure 5

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