Major Upper-Limb Amputations for Malignant Tumors

Puhaindran, Mark E.; Chou, Joanne F.; Forsberg, Jonathan A.; Athanasian, Edward A.

doi:10.1016/j.jhsa.2012.02.004

Cited by 24 publications

(17 citation statements)

References 19 publications

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“…Three patients were lost to clinical follow‐up, but at the time of the last follow‐up were without evidence of disease. These results are similar to those observed in similar studies of patients undergoing amputation for oncologic reasons with local recurrence occurring in 7%‐36% of patients . Wound complications requiring a return to the operating room occurred in 16% (5/31) of patients, including one patient who initially underwent a below‐knee amputation with TMR who required conversion to an above knee amputation with TMR because of a nonhealing stump wound.…”

Section: Resultssupporting

confidence: 84%

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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Background We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. Methods Our TMR cohort was compared to a cross‐sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient‐Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. Results Thirty‐one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow‐up (mean follow‐up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159‐10.55; P = .015), 5.896 (95%CI 0.492‐11.30; P = .033), and 7.435 (95%CI 1.797‐13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528‐10.42; P = .031), 6.195 (95%CI 0.705‐11.69; P = .028), and 6.816 (95%CI 1.438‐12.2; P = .014), respectively. Fifty‐six percent took opioids before amputation compared to 22% at 1 year postoperatively. Conclusions Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee‐centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.

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Section: Resultssupporting

confidence: 84%

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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“…Tumors and congenital deformities were the causes of only a low percentage of amputations in our study (10 cases (4.62%)). This may be due to scientific progress and the prevention of amputations from these causes, or it may be due to the fact that amputation is reserved for very advanced cases, especially of the upper limb (23). Most of our amputations were performed in the lower limbs like other studies (4, 16).…”

Section: Discussionmentioning

confidence: 99%

Amputation: A Ten-Year Survey

Sarvestani¹,

Azam²

2013

Trauma Mon

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BackgroundLimb loss occurs due to different causes and has been increased in many countries. It has without exception, great economic, psychological and social impacts.ObjectivesThis study assesses the demographics of amputees in one city of Iran.Patients and MethodsThis retrospective study was undertaken on all of the amputees between April 2002 and December 2011. Patients’ demographics including age, sex, the amputated limb, etiology of limb loss and level of amputation were recorded.ResultsWe had 216 patients in the study. The average number of amputations was 21.6 per year and varied from 14 to 32. The mean age of amputation was 39.26± 12.6 years. Of the patients, 172 were male (79.62%) and 44 female (20.37%); 119 of the amputations (55.09 %) were major and 97 minor (44.9 %). The most common cause of amputation was trauma and the most common was the toe. In trauma patients the mean age was 38.12± 10.25 years and 98 (83.7%) were male.ConclusionsIn contrast to similar studies in developed countries, trauma was found to be the major cause of all types of amputations. Results of this study may be used in prevention planning.

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“…In the preoperative planning, careful assessment of tumor involvement of neurovascular structures is critical, because this may necessitate nerve or vessel reconstruction or preclude the possibility of limb salvage. 61,62 For example, the clinical triad of intractable pain, motor deficit, and venography showing obliteration of the axillary vein has been postulated as being predictive of brachial plexus involvement. 62 During the planning for surgical resection, consideration should be given to the reconstruction of the bony, neurovascular, and soft tissue defects after tumor resection.…”

Section: Wide Resectionmentioning

confidence: 99%