R Neinstein, AB Death, BS Gan. The combined plastic surgery/physical medicine and rehabilitation amputee clinic at the University of Western Ontario. Can J Plast Surg 2008;16(1):23-26.Since the autumn of 2001, a multidisciplinary plastic surgery (PS) and physical medicine and rehabilitation (PMR) outpatient amputee clinic has been in place at St Joseph's Health Centre/Parkwood Hospital in London, Ontario. To date, more than 140 new patients have been seen in combined consultations. The present paper reviews the demographics, interventions and outcomes of the patients seen between 2001 and 2005. The majority of primary PMR patients had problems that prevented optimal use of their lower extremity prostheses. These problems included nonhealing pressure ulcers, infections, painful neuromas, amputation stump shape abnormalities and fixed joint contractures. Most patients had surgical intervention. In terms of overall clinical success, 53% of the PMR patients and 77% of the PS patients had their problems resolved. The multidisciplinary collaboration in the PS/PMR outpatient amputee clinic provides a unique service that benefits upper and lower extremity amputees. T he fundamental principle of plastic surgery (PS) is to restore form and function. Thus, it seems logical that plastic surgeons should be involved with those who have absence of form, such as amputee patients. Many of the problems associated with amputation are related to the shape of the stump, which often requires soft tissue rearrangement. Other stump problems include osteocutaneous adhesions, bony prominences, poor soft tissue coverage or redundant skin, and chronic wounds. Despite an almost natural fit with PS, most amputee care is provided by specialists in physical medicine and rehabilitation (PMR) and not by plastic surgeons. To our knowledge, there is no previous description of a combined PS and PMR clinic devoted to treating amputee patients. At the University of Western Ontario, London, Ontario, such a combined clinic was established in the autumn of 2001. While initially a bimonthly clinic, the demand rose quickly and the clinic became a monthly occurrence. The purpose of the present paper is to review the operative and nonoperative contributions plastic surgeons can make to an amputee clinic and to review the benefits of the multidisciplinary PS/PMR outpatient amputee clinic at the Parkwood Rehabilitation Hospital, University of Western Ontario. METHODSRetrospective data were collected on all patients seen in the combined PS/PMR outpatient amputee clinic at St Joseph's Health Centre/Parkwood Rehabilitation Hospital between autumn 2001 and summer 2005. Demographic data, including clinical problems and questions, number of visits, type of intervention, outcome and complications, were reviewed. Only patients who had a treatment plan instituted (either nonoperative or operative) were included. Patients who were seen within the study period but had no treatment instituted at the time of the review were not included. Treatment success (whether surgica...
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