Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
A reappraisal of a modified through-knee amputation in patients with peripheral vascular disease
Autore:
Cull, DL; Taylor, SM; Hamontree, SE; Langan, EM; Snyder, BA; Sullivan, TM; Youkey, JR;
Indirizzi:
Greenville Hosp Syst, Dept Surg Educ, Vasc Surg Serv, Greenville, SC 29605USA Greenville Hosp Syst Greenville SC USA 29605 erv, Greenville, SC 29605USA
Titolo Testata:
AMERICAN JOURNAL OF SURGERY
fascicolo: 1, volume: 182, anno: 2001,
pagine: 44 - 48
SICI:
0002-9610(200107)182:1<44:AROAMT>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
LOWER-EXTREMITY AMPUTATION; ABOVE-KNEE; LOWER-LIMB; REHABILITATION; FLAP;
Keywords:
through-knee amputation; knee disarticulation technique; peripheral vascular disease; modified technique;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Cull, DL Greenville Hosp Syst, Dept Surg Educ, Vasc Surg Serv, 701 Grove Rd, Greenville, SC 29605 USA Greenville Hosp Syst 701 Grove Rd Greenville SCUSA 29605 605 USA
Citazione:
D.L. Cull et al., "A reappraisal of a modified through-knee amputation in patients with peripheral vascular disease", AM J SURG, 182(1), 2001, pp. 44-48

Abstract

Background: Through-knee amputation provides a longer lever arm and improved muscle control of the limb compared with above-knee amputation: Through-knee amputation also allows use of a total end-bearing prosthesis, which avoids the ischial pressure and suspension belts required of the above-knee amputation prosthesis. Several reports in the European literature tout the superiority of the through-knee amputation over the above-knee amputation inthe patient with vascular disease. Through-knee amputation has received little attention in the United States, however, owing to the belief that the long flaps necessary to close a standard through-knee amputation are associated with an unacceptable rate of wound problems and offer no functional ambulatory advantage to above-knee amputation. We reviewed our experience with a modified technique of through-knee amputation in a group of patients with severe lower extremity ischemia who were not candidates for below-knee amputation to determine the incidence of wound complications and their functional outcome. Methods: Since 1996, 12 patients with severe lower extremity arterial insufficiency have undergone through-knee amputation utilizing a technique designed to limit flap length and facilitate the fit of a suction prosthesis. Two patients died of myocardial infarction in the immediate postoperative period and were excluded from the study. In the remaining 10 patients (1 man,9 women; mean age 63 years (range 40 to 86), the below-knee amputation level was precluded because of gangrene or nonhealing wounds of the mid leg in5 patients, failure of a previous below-knee amputation attempt in 4 patients, and severe ischemia that would compromise below-knee amputation healing in 1 patient. Nine patients had at least one failed vascular reconstruction procedure. Results: Mean follow-up is 25 months (range 6 to 41). Six (60%) patients had primary healing of their amputations. Two (20%) patients had delayed healing (6 weeks and 8 weeks). Two (20%) patients developed wound infections, which required amputation revision to the above-knee level. Seven (70%) patients were fitted with a suction socket prosthesis and are fully ambulatory. One patient healed but has not ambulated because of ischemia and subsequent ulceration of the contralateral limb. Conclusions: These data show that through-knee amputation is associated with an acceptable primary healing rate (80%) and satisfactory functional outcomes (70% ambulation) in a high-risk vascular population. The functional advantages of through-knee amputation over above-knee amputation make it thepreferred alternative for patients with vascular disease. (C) 2001 Excerpta Medica, Inc. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 12/08/20 alle ore 17:38:54