This report describes the value of infrared thermography in assessing the optimum level of amputation of an ischemic limb. Interpretation of thermograms and the factors that can significantly alter the thermal image of the lower limbs are detailed. Results from 104 patients demonstrate that the thermographic method is a reliable indicator of the level of a major limb amputation. A rationale for the inadequacy of the method when attempting to determine the outcome of a partial foot amputation is considered.

A review of fifty patients with wide ranging clinical conditions who had been fitted with one-piece moulded plastic spinal orthoses was carried out to determine prescription criteria for these orthoses. The review showed that patients with scoliosis (idiopathic and paralytic), kyphoscoliosis, as well as a selected number of patients with low back pain derive benefit. Patients with kyphosis and localized vertebral body disease are unlikely to gain benefit since they commonly cannot tolerate the excessive skin pressures which occur as a consequence of the corrective and distractive forces applied by the devices.

The use of a new method of improving certain physical aspects of the environment imposed on the extremity is discussed. This follows the use of Controlled Environment Treatment in amputation surgery and other specific conditions within a controlled trial in several Centres in the United Kingdom and United States of America. The protocol did not attempt to establish any system of controls, the results being based on observation and clinical impression. In other words it is an extension of CET use in an attempt to obtain a wider experience of its application. One hundred cases involving 128 treatments are listed over a wide variety of clinical presentations. Recordings were made of the presence or absence of oedema, infection, ischaemia and pain, amongst other relevant data. Certain conclusions proved possible and staff acceptance of the system was obtained. The evidence suggests that the continued use of CET is justified in certain carefully selected clinical conditions. Further, it appears necessary to set up controlled scientific assessments of the system particularly within vascular laboratories where many relevant investigative procedures are carried out on a routine basis.

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