Reamputation rates, morbidity and rehabilitation after lower limb amputations

Abstract

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.

To determine the acute stump complications in major amputation occurring in hospitalized diabetic foot patients through Amit Jain’s typing and scoring system: A prospective study

“…In Chalya et al series [2] , 21% of them had wound infection of stump and 3.1% had wound dehiscence. In Umaru et al series, 28.3% had wound infection and 12.3% had wound dehiscence [22] . In Salawu et al series [25] , 10.7% had wound infection and 6.4% had flap necrosis after major amputation of extremities.…”

“…Recent studies done by Jain et al found the major amputations in diabetic foot in major teaching hospitals to be between 16% to 20% [19,20] . Major amputation in diabetes patient is associated with significant social, economic and psychological impact on patients and their families along with decreased survival [21,22] . Further, major amputations have stump complications that increases morbidity, prolonged hospitalization and cost of treatment.…”

A New Classification for Diabetic Foot Problems

“…Once a patient has amputation being done for diabetic foot, it does not mean that he will be free from other problems arising from it. Many patients will have to use prosthesis in case they underwent major amputation (Vishwakarma, N. et al, 2019). Prosthesis related problems are well known.…”