The predictive value of the pedal transcutaneous oxygen tension (tcPO2) and of the distal systolic blood pressure (SBP) in forecasting the necessity for later amputation has been studied in 26 patients suffering from severe chronic ischaemia of the lower limbs. In all these patients vascular surgery had failed or not been possible, and they were threatened by amputation; they suffered from trophic lesions, or pain at rest, or both. The great toe SBP averaged 10 mmHg (range 0 to 60 mmHg) and the pedal tcPO2 10 mmHg (range 2 to 45 mmHg). After six minutes of oxygen inhalation there was an increase in pedal tcPO2 of 9 mmHg (0 to 50 mmHg). After a follow-up period averaging 7 months (range 10 days to 13 months), 13 patients underwent an amputation and nine (five of whom had been amputated) died. The great toe SBP in the patients who required amputation was initially lower than in those who did not. The pedal tcPO2 also was lower in amputated than in non-amputated patients. There was no amputation in the group showing an increase of at least 10 mmHg after six minutes of oxygen inhalation; and conversely, all patients in whom the pedal tcPO2 increased less than 10 mmHg were amputated. Thus increase in the pedal tcPO2 after oxygen inhalation appears the best criterion for estimating the prognosis of severely ischaemic limbs

A retrospective study of 260 industrial amputees was undertaken to determine the long-term functional results of partial foot amputations following trauma. Follow-up ranged from 1 to 68 years with a mean of 16 years. Of 113 partial foot amputees (118 amputations) who had retained their original amputation, the functional end-results were 43% good, 38% fair and 19% poor. Lisfranc and Chopart amputations were better than those at transmetatarsal or digital levels. Of 260 initial amputations 49 (19%) were revised to a Syme's or a below-knee amputation

The Mangled Extremity Severity Score was applied to 152 patients with severely injured lower limbs. All cases with a score of seven or more required amputation; some with scores of less than seven eventually came to amputation. These observations are discussed

Management of the failed total knee replacement is a formidable problem. In a 13-year period, 24 patients with above knee amputation following unsuccessful knee replacement were referred for prosthetic limb fitting. Adequate data was available for 23 patients. At review (or at the time of death), an average of 48.6 months after amputation, only seven of the 23 patients were regular daily walkers, although 10 patients had managed to walk for more than two years; 20 of the 23 used a wheelchair for some part of the day and 12 were confined to a wheelchair

We reviewed 34 hindquarter amputations performed for malignant tumours around the hip from 1971 to 1988, classifying them as palliative or curative according to the resection margins or the presence of disseminated disease at the time of surgery. There were three peri-operative deaths, 12 palliative and 19 curative procedures. Ten patients died of disseminated disease within a year of surgery, eight of whom had had a palliative operation. Three patients died between one and five years after palliative surgery. One died of unrelated disease at nine years. Seventeen patients are disease free an average of 31 months from surgery, 16 after curative procedures. The median survival after palliative amputations was six months and the 5-year survival rate for curative cases was 83%

A programme for early mobilisation using a temporary prosthesis was evaluated in 17 children who had had an amputation above the knee for sarcomata. The temporary prosthesis had a performed adjustable polypropylene quadrilateral socket which was able to accommodate changes in the size of the stump during the first few months after amputation. The adjustable sockets were assembled onto wooden knee-shank-foot units or onto modular components covered with foam. The wooden units were better for routine use as more adjustment was possible between the socket and the knee and because they were more durable in active children. Prosthetic fitting usually took one hour and was carried out 10 days after the amputation to coincide with the start of the chemotherapy programme. The prosthesis was cosmetically acceptable, easy to use and provided a simple and economical way of rehabilitating the amputees and restoring their morale. After two to three months a new prosthesis with a laminated socket suspended by a waistband was supplied. The skin tolerated the closer fit of this socket and the small fluctuations in the size of the stump that occurred with each course of chemotherapy were easily accommodated by varying the thickness of the stump sock. A self-suspending laminated socket was provided after completion of the chemotherapy. The permanent sockets were assembled onto wooden components but the girls usually preferred the modular system covered with foam. The chemotherapy and rehabilitation programmes were successfully co-ordinated so that the children spent as little time as possible away from their normal activities

Aims. This study describes the Osseointegration Group of Australia’s Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated reconstruction of amputated limbs. Patients and Methods. We report clinical outcomes in 50 unilateral trans-femoral amputees with a mean age of 49.4 years (24 to 73), with a minimum one-year follow-up. Outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation, the health assessment questionnaire Short-Form-36 Health Survey, the Amputation Mobility Predictor scores presented as K-levels, 6 Minute Walk Test and timed up and go tests. Adverse events included soft-tissue problems, infection, fractures and failure of the implant. Results. Our results demonstrated statistically significant improvements in all five outcome measures. A total of 27 patients experienced adverse events but at the conclusion of the study, all 50 were walking on osseointegrated prostheses. Conclusion. These results demonstrate that osseointegrated prostheses are a suitable alternative to socket-fit devices for amputees experiencing socket-related discomfort and that our strategy offers more rapid progress to walking than other similar protocols. Cite this article: Bone Joint J 2016;98-B:952–60

Leg amputation levels were decided in 24 patients suffering from atherosclerosis, using the conventional techniques of segmental blood pressure and radioisotope skin clearance. The skin microcirculation was measured and recorded before operation with a laser doppler flowmeter. A high correlation was found between the successful amputation levels and the maximal blood perfusion of the skin measured in this way

The present study was undertaken to investigate the effect of fluorocarbon on the preservation of an amputated limb. The hind limbs of dogs were completely amputated through the mid-thigh; some were perfused with fluorocarbon, others with lactated Ringer's solution and some were not perfused at all. After six hours of ischaemia, all the limbs were replanted. Perfusion with fluorocarbon had an inhibitory effect on the anaerobic metabolism of an amputated limb, thus increasing the survival rate. Leakage of creatine phosphokinase from the replanted limb also was inhibited by perfusion with fluorocarbon. These effects were more striking when the amputated limb was perfused continuously rather than intermittently and when it was preserved in iced water rather than at room temperature; these measures helped to prevent replantation toxaemia and to preserve muscle function

We have reviewed the results of amputation through the ankle in the management of 37 children with congenital leg-length discrepancy, followed up for a mean of 7.6 years after operation. In general good function was achieved and 18 patients considered their activities to be unrestricted. The main factor affecting the functional result was the underlying condition for which operation had been performed. Although heel pad migration, scar rotation and os calcis remnants were seen, these could be accommodated by the prosthesis. Syme's amputation is tolerated well in the younger child and, in patients with a predicted leg-length discrepancy of over 15 cm associated with an abnormal foot, we recommend the operation as a primary procedure between the ages of 18 months and two years

We describe a method of partial limb salvage for the treatment of large primary malignant tumours of the arm. The tumour-bearing area is resected as a cylindrical segment and the distal arm is then replanted with the necessary shortening. The method is suitable for stage-IIB tumours with or without neurovascular involvement which, because of their extent, could otherwise be adequately treated only by amputation. From 1987 to 1992 we used this method in 12 patients with primary malignant bone or soft-tissue sarcomas. Wide resection margins were achieved in all, but six patients died from their disease at a mean of 21.5 months (6 to 48), none with any local recurrence. Five patients have no evidence of disease at a mean follow-up period of 52.2 months (22 to 78), and one was lost to follow-up at 48 months postoperatively when there was no evidence of disease. The results of the functional evaluation of ten patients with a follow-up of over ten months were excellent in one, good in six and fair in three, by the criteria of Enneking (1987). Recovery after nerve reconstruction was satisfactory in all cases with sensation S3 or higher and motor function M2+ or higher. Detailed evaluation of hand function on the Millesi score rated only 22% (9.6% to 33.7%) as compared with the contralateral side, but the patients were satisfied and refused further operations for the improvement of function. These oncological and functional results allow us to recommend resection-replantation as a valuable alternative to amputation for the treatment of primary malignant tumours of the arm

One hundred and eighty-three conservative amputations of some part of the foot in 161 patients with gangrene from diabetes or arteriosclerosis have been studied retrospectively. They constituted 48 per cent of all amputations in one orthopaedic service over a period of twelve years, during which the minimal feasible procedure was always chosen. Sixty per cent healed soundly, but in over a third of these cases at least one revision to a higher level on the foot had been required. Factors that significantly influenced the outcome of the initial operation were the level of amputation, the age of the patient, the interval between the onset of gangrene and operation, anaemia and pyrexia

We present a rare case of multifocal Proteus mirabilis osteomyelitis in an HIV-positive patient. Despite the patient’s good immune status as assessed by her CD4 cell count and the aggressive treatment, she eventually underwent bilateral above-knee amputations to eradicate the infection. Multifocal Proteus mirabilis osteomyelitis can have an unpredictable clinical course with a severe outcome in HIV-positive patients

The June 2023 Foot & Ankle Roundup³⁶⁰ looks at: Nail versus plate fixation for ankle fractures; Outcomes of first ray amputation in diabetic patients; Vascular calcification on plain radiographs of the ankle to diagnose diabetes mellitus; Elderly patients with ankle fracture: the case for early weight-bearing; Active treatment for Frieberg’s disease: does it work?; Survival of ankle arthroplasty; Complications following ankle arthroscopy.

Patients with short congenital amputations below the elbow often function as if they have had a disarticulation of the elbow. We have reviewed the results in six patients who had lengthening of such stumps by the Ilizarov technique to improve the fitting of prostheses. The mean lengthening was 5.6 cm (3.4 to 8.4), and in two patients flexion contractures of the elbows were corrected simultaneously. Additional lateral distraction was used in one patient to provide a better surface on the stump. There were no major complications. All six patients were able to use their prosthesis at the latest follow-up after 39 to 78 months

We describe the technique of wedge resection for revision of an amputation stump, and report the results of this at below-knee level in 57 patients with peripheral vascular disease; healing occurred in 42 of these (74%)

In 42 amputations (28 below-knee and 14 above-knee), healing of the stump was found to correlate with the pre-operative transcutaneous oxygen pressure (tcPO2) measured at the planned site of incision. Of 31 patients with a tcPO2 of 30 mmHg or more, 27 healed primarily, three had delayed healing and one failed to heal; of seven patients with values between 20 and 30 mmHg three healed primarily and four had delayed healing; and all four patients with a value below 20 mmHg had stumps which failed to heal and needed reamputation. It is concluded that a tcPO2 of 20 mmHg or more at the intended site of amputation indicates that the wound will heal

We studied the effect of transcutaneous electrical nerve stimulation (TENS) on stump healing and postoperative and late phantom pain after major amputations of the lower limb. A total of 51 patients were randomised to one of three postoperative treatment regimens: sham TENS and chlorpromazine medication, sham TENS only, and active low frequency TENS. There were fewer re-amputations and more rapid stump healing among below-knee amputees who had received active TENS. Sham TENS had a considerable placebo effect on pain. There were, however, no significant differences in the analgesic requirements or reported prevalence of phantom pain between the groups during the first four weeks. The prevalence of phantom pain after active TENS was significantly lower after four months but not after more than one year