Background: This study attempted to document the indications for lower limb amputation (LLA) and its outcomes especially the wound healing problems, reamputations and subsequent use of prosthesis for mobilization in Indian population.Methods: This observational study included 92 patients over a period of 18 months. Indications, level of LLA, morbidity and reamputation rates after LLA were recorded. Stump status, wound healing and other morbidity was followed over period of one month. The use of prosthesis and level of mobility were assessing in follow-up over a period of six months.Results: There were total 109 LLA in 92 patients as some of these patients had to undergo revision of amputation stump at a higher level. Atherosclerosis (29.3%) was the main cause for LLA. Age group 35-55 years and male patients were most commonly needed LLA. Total 64.13% patients developed post-operative wound infection and 18.4% patients underwent reamputation. E. coli and Staphylococcus were the most common organism cultured from the infected surgical site. Conversion of below knee amputation (BKA) to above knee amputation (AKA) was the most frequent reamputation and atherosclerosis was the leading cause. According to final level LLA, 54 had major amputations (above ankle joint), only 37% were using a prosthesis whereas majority of patients were dependent on crutches/walker.Conclusions: Patients of atherosclerosis and trauma had a higher frequency of reamputations. Only 37% of major LLA opted for prosthesis whereas majority of patients mobilize by other means like crutches or walker.
Background: Evaluation of axilla using sentinel lymph node biopsy (SLNB) is the standard of care in node negative early breast cancer. Intra operative assessment of SLNB with frozen section (FS) often guides the surgeon regarding decision for level of axillary dissection. The aim of this study was to evaluate accuracy of FS of SLNB in these patients with histopathology examination (HPE) as the gold standard.Methods: This study was performed between July 2017 and November 2018. After gross evaluation of SLNB, nodes were cut in half and frozen; the other half was preserved for HPE. For FS, nodes were sectioned to 4 mm width and examined.Results: A total of 61 patients underwent SLNB, 55 patients undergoing intra-operative FS. The mean age was 53 years (range 30-84, ± 15.09 SD), primary tumor was clinically T1 in 23.6%, T2 in 76.4% patients. A median of four sentinel nodes were identified, mean size 13.84 mm. On FS SLNB was positive for metastasis in 14 (25.5%), on HPE in 16 (29.1%) patients. There were 13 true positive, 38 true negative, 3 false negative and 1 false positive result for FS. The sensitivity, specificity, positive and negative predictive value, false negative and false positive rates were 81.25%, 97.44%, 92.86%, 92.73%, 18.75% and 2.56% respectively in this study. The overall accuracy of FS of SLNB in early carcinoma breast was found to be 92.73%.Conclusions: An intra-operative FS of the SLN in node negative early breast cancer is a highly sensitive tool in axilla management.
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