Influence of post-amputation pain syndrome on blood circulation in the bone residual limb

Abstract

Background. The percentage of unsatisfactory amputation results is still high. The healing of the bone remnant, the main supporting element of the residual limb, is of particular importance. The purpose was to study the effect of post-amputation pain syndrome on the nature of blood circulation in the bone residual limb. ­Materials and methods. Three series of experiments with amputation of the thigh were conducted on 54 rabbits. In the series 1 and 2, a perineural catheter was brought to the stump of the sciatic nerve. In series 1, for 20 days, ­every day for 20 minutes, mechanical irritation of the nerve was done, causing a pain syndrome using the perineural catheter. In series 2, 0.3 ml of 1% lidocaine was injected twice daily for 20 days; series 3 was a control. The follow-up periods were 1, 3, and 6 months. The study method was histological with the infusion of vessels with an ink-gelatin mixture. Results. Animals of the first series developed avascularity of the end of the stump and bone marrow, poor vascularity and absence of cellular composition in the Haversian canals, dystrophic changes in adipose bone marrow, rarefication, spongiosis, resorption, and bone fractures. In series 2, the avascularity passed quickly and by three months, the angioarchitectonics was stabilized. Revascularization of the bone stump occurs due to the preserved sources of blood circulation (intramedullary vascular network, periosteum and surrounding soft tissues) anastomosing vessels and extravascular pathways of microcirculation (increased vascular permeabi­lity, formation of sinusoidal capillaries and tissue cysts). In most observations of series 3, the processes of revascularization were similar to the results of the 1st series. Conclusions. Postamputation pain syndrome causes abrupt macro- and microcirculatory disturbances. Pain syndrome suppression allows to considerably level the arising circulatory disorders in the bone residual limb.

Remodeling of the Fibula Stump After Transtibial Amputation

“…The remodelling cycles continue until the restoration of stable relations between the blood supply pools of bone, which ensure the preservation of tissue homeostasis and bone structure. 11,20 For normal healing of the end of the bone stump, it is necessary to achieve such conditions as tight closure of the medullary canal with muscle or graft and rest during the period of active regeneration. 10 Unfortunately, achieving immobility of the fibula end is a difficult task.…”

“…A characteristic feature of such a residual limb is the completion of intensive reparative processes. 20 In group 1, when the muscle plasty was correctly performed, limiting the balloting of the fibula remnant and overlapping its medullary canal, the residual limb was a painless organ with the completion of reparative processes, stable shape, a bony closure plate at the end, normal medullary content, moderately ongoing remodelling processes and a dense fibrous coating at the end of the bone, allowing painless loading in a full-contact prosthesis. The absence of fresh endosteal and periosteal bone formation and active remodelling at a distant time indicated the equilibrium of osteoreparation and resorption processes and the completion of the reparative process.…”

“…The remodelling cycles continue until the restoration of stable relations between the blood supply pools of bone, which ensure the preservation of tissue homeostasis and bone structure. 11 , 20 …”

“…A characteristic feature of such a residual limb is the completion of intensive reparative processes. 20 …”