Effect of a failed distal reconstruction on the level of amputation

Factors affecting wound healing after major amputation for vascular disease

“…The single most readily available test is the Doppler-derived measurement of systolic pressure. Some evidence supports the use of a thigh and/or ankle pressure of 50-70mmHg as a criterion for successful healing after major amputation (Barnes et al., 1976;Dean et al, 1975;Evans et al, 1990;Holstein, 1973;McCollum and Walker, 1992;Pollock et al, 1980;Schwartz et al, 1982), although calcified non-compressible arteries, often found in diabetic patients, give falsely elevated values for thigh and ankle pressures (Gibbons et al, 1979;Raines et al, 1976). Various other tests, such as segmental systolic pressure (Baker et al, 1977;Dean et al, 1975), skin perfusion pressure and/or blood flow (Adera et al, 1995;Dwars et al, 1992;Holloway and Burgess, 1983;Holstein et al, 1979;Karanfilian et al, 1986;Lantsberg and Goldman, 1991;Malone et al, 1981) and TcPo2 (Burgess et al, 1982;Padberg et al, 1996;Wutschert and Bounameaux, 1997;Weiss et al, 1988) have been described as predictors of healing after amputation.…”

Relative mortality and long term survival for the non-diabetic lower limb amputee with vascular insufficiency

“…As regards the two first mentioned factors it seems obvious that these factors are enhanced by centralisation. The influence of vascular surgery on the epidemiology of amputations is well-documented (Holstein, 1996;Ebskov et al, 1994;Eickhoff, 1993;Pedersen et al, 1994;Mattes etal., 1997) but the epidemiological interactions in relation to level of amputation (and long term survival) are less simple and are controversial (Burgess and Marsden, 1974;Sethia et al, 1986;Tsang et al, 1991;Gregg, 1985;Kazmers et al, 1980;Evans et al, 1990;Dardik et al, 1982). Stewart et al (1993) found that 54% of the vascular cases in Dundee Limb Fitting Centre had a history of vascular surgery prior to amputation and that failed vascular surgery deteriorates the TT/TF ratio.…”

Lower leg replantation—Decision‐making, treatment, and long‐term results

“…9 It is known that a patient can die from replantation/revascularization at the upper limb. 10,[57][58][59][60] Thus if the patient's general conditions get worse inspite of intensive care treatment early re-amputation (Table 3) is the only way to save the life. Most acute re-amputations are due to errors in the decision-making in favor or against replantation.…”