Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team

Sansosti, Laura E.; Crowell, Amanda; Choi, Eric T.; Meyr, Andrew J.

doi:10.7547/16-073

Cited by 16 publications

(6 citation statements)

References 31 publications

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“…Concerning sex, the findings showed that more than half of patients in both control and study groups were male. These findings are in line with Sansosti et al (2017) (33) who found that more than half of patients with unilateral major lower limb amputation were male. It might be due to men are more reluctant than women to seek medical help when they are ill and they engage in risk-taking activities that can seriously threaten their well-being and life.…”

Section: Discussionsupporting

confidence: 91%

Effect of a Rehabilitation Program on the Quality of Life of Patients with Lower Limb Amputation

Rabie

Salem

et al. 2020

Alexandria Scientific Nursing Journal

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Section: Discussionsupporting

confidence: 91%

Effect of a Rehabilitation Program on the Quality of Life of Patients with Lower Limb Amputation

Rabie

Salem

et al. 2020

Alexandria Scientific Nursing Journal

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“…60% of our patients were ambulatory at a mean of 9.5 months follow-up. 2,11,15 This rate is greater than, but comparable to, other studies’ findings. Wong et al 16 reported a 50% 1-year ambulation rate in a patient cohort similar to ours.…”

Section: Discussionsupporting

confidence: 84%

“…Consequently, the principal postoperative focus is adequate stump healing, which can significantly improve the likelihood of ambulatory success if achieved free of complication. 15 92% of our patients healed completely with a mean healing duration of 6 months, and 29% did so within 1 month. This healing rate exceeds figures reported in previous studies with cohorts of dysvascular amputees.…”

Section: Discussionmentioning

confidence: 63%

Popliteal artery patency is an indicator of ambulation and healing after below-knee amputation in vasculopaths

et al. 2021

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Background The posterior flap is a conventional technique for closing a below-knee amputation (BKA) that uses the gastrocnemius and soleus muscle and relies on the popliteal and posterior compartment arteries. If the prior mentioned arterial blood supply is compromised, this flap likely relies on collateral flow. The purpose of this study is to identify and differentiate any significant associations between preoperative popliteal and tibial arterial flow and BKA outcomes and patient-reported function. Methods A retrospective review identified patients from a single tertiary wound care center who received BKAs and angiogram between 2010 and 2017 by a single surgeon. BKA complications, wound healing, and amputee ambulatory status at latest follow-up were all stratified for differences according to baseline tibial vessel run-off (VRO) status, popliteal artery patency, and popliteal angioplasty outcome. Chi-square, Fisher’s exact, and Wilcoxon rank sum tests were used with significance defined as p ≤ 0.05 . Results BKAs were performed on 313 patients, of which, 167 underwent preoperative angiography. Thirty-two were excluded due to lack of adequate follow-up leaving a total of 135 patients in the studied population. Diabetes was present in 87%, and 36% had end-stage renal disease. By the study’s conclusion, 92% of BKAs had fully healed, with median time-to-healing of 79 days (range 19–1314 days). 60% of patients were ambulatory at 9.5 months. Higher VRO was associated with higher healing rates and lower complications and time-to-healing. The conversion rate of BKA to above-knee amputation (AKA) was 4%. Preoperative popliteal patency was associated with higher postoperative ambulation rates when compared to patients without popliteal flow preoperatively (patent: 71/109, 65%; occluded: 10/26, 40%; p = 0.02) and independently increased the likelihood of postoperative ambulation. Conclusions The posterior flap design for BKA works even in the setting of popliteal occlusion. Complication rates are higher in patients with more compromised blood flow, which may ultimately lead to AKA. Given poor ambulation rates in patients who undergo AKA, the results of this study should encourage surgeons to consider a more functional BKA, even in instances when the popliteal artery is occluded.

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“…11,28 Corresponding data for TFA are 15%-50%. 27,[29][30][31] Differences can be explained by patient selection in studies, as well as lack of routines for referrals to amputee clinics or the acute situation at surgery, which could have affected the choice of amputation level. Standardized routines can minimize the risk for patients to be denied the possibility to adequate rehabilitation at an amputee clinic.…”

Section: Discussionmentioning

confidence: 99%

Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease

Sjödin,

Ottosson,

Lapidus

2023

Prosthetics &Amp; Orthotics International

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Objective: Our aim was to compare transfemoral amputation (TFA) to knee disarticulation (KD) as a reamputation level after failed transtibial amputation (TTA) in patients with peripheral vascular disease and/or diabetes. Methods: We studied 152 patients undergoing reamputation, 86 TFA and 66 KD, after a failed TTA. The primary outcome was reamputation and reoperation, and secondary outcomes were prosthetic fitting and mortality. Logistic regression analyses were performed to identify factors associated with the outcome. Results: The reamputation rate was 36% after KD and 15% after TFA (p = 0.004). The multivariable analysis showed that TFA was associated with a significantly reduced risk of reamputation, odds ratio (OR) = 0.31 (95% confidence interval [95% CI], 0.1–0.7). The overall reoperation rate was 38% after KD and 22% after TFA (p = 0.03). This reduction of risk for TFA was not significant in the multivariable analysis, OR = 0.49 (95% CI, 0.2–1.0). Prosthetic limb fitting was possible in 30% after KD and 19% after TFA (p = 0.1). Previous amputation in the contralateral leg was the only factor associated with reduced ability for prosthetic fitting in the multivariable analysis, OR = 0.15 (95% CI, 0.03–0.7). Mortality at 30 d was 17% and 53% at 1 year. No independent factors affected 30-d mortality in the multivariable analysis. Conclusions: In this study, we found a significantly lower risk of reamputation after TFA compared with KD after a failed TTA. We consider TFA to be the reamputation level of choice, especially when there is a need of reducing risk of further reamputations.

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Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team

Abstract: These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.

Cited by 16 publications

References 31 publications

Effect of a Rehabilitation Program on the Quality of Life of Patients with Lower Limb Amputation

Effect of a Rehabilitation Program on the Quality of Life of Patients with Lower Limb Amputation

Popliteal artery patency is an indicator of ambulation and healing after below-knee amputation in vasculopaths

Knee disarticulation vs. transfemoral amputation after failed transtibial amputation: Surgical outcome and prosthetic fitting in patients with peripheral vascular disease

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