截肢与装配假肢的临床体会

近十多年 ,随着生物力学基础理论研究的深入 ,有关截肢手术与假肢安装的观点已有了很大的变化 ,尤其是机械电子工业的发展 ,使假肢业有了突破性的进展。临床资料我们对 4年来装配的 2 15例假肢的残肢处理及截肢方法进行了回顾 ,发现符合现代假肢要求者仅占 34 %。使大多数患者装配假肢后因残肢条件不良 ,或者有并发症不能很好的发挥假肢功能 ,其中有 16例需要再手术处理。常见的残肢并发症有大腿截肢合并髋关节屈曲外展畸形 ,小腿截肢合并膝关节屈曲畸形 ,小腿截肢合并腓骨外展畸形 ,皮肤大片瘢痕 ,皮肤溃疡 ,较严重的残肢痛 ,神经瘤 ,残肢…     

对截肢与假肢一些问题的探讨

作者就３年来住院截肢患者７３例进行讨论，丙工假肢发迹了传统开放的塞入式接受腔为闭合的全面接触式接受腔，截肢技术已改进，主要是残端肌肉瓣固定术和成形术，神经残端结扎。强调了截肢部位的选择。临时假肢可加速残肢定型和早期功能训练。康复训练对减少并发症和发挥假肢代偿功能是非常重要的。     

再造更佳功能的残肢——从假肢安装效果对截肢术提出新建议

目的：目前截肢后的残肢端部大多不能承重，也不能悬吊假肢，影响了残肢功能和假肢安装效果，本文提出了解决以上问题的方法。方法：截肢时对残肢骨端实施再造术，植入人工骨端。结论：此方法将使残端能承受体重，且能自然悬吊假肢，极大地改善了残肢功能和假肢安装效果。     

缺血性肢体截肢的康复护理

随着糖尿病患者和血栓闭塞性脉管炎患者的不断增加，由周围血管疾病引发的截肢术呈上升趋势，这其中老年患者占了75％的比例。而现代假肢技术的发展和人们对健康生活质量的追求，都对缺血性肢体截肢手术及其护理提出了更高的要求，恰当的手术、良好的残端和关节功能对患者术后假肢装配、残肢功能重建十分重要^[1]。为此，本文就缺血性肢体截肢术的护理与康复内容综述如下。     

糖尿病足截肢技术进展

目的总结各种糖尿病足截肢技术的研究进展。方法查阅近年关于糖尿病足截肢技术的文献,进行综合分析。结果根据截肢平面的不同,糖尿病足的截肢技术可分为小范围截肢术和大范围截肢术两种,并衍生出多种截肢方法,截肢方式与方法的选择需要综合各种因素考虑。结论 对于糖尿病足截肢,应在保证截肢效果的前提下,尽可能降低截肢平面。患者的身体状况、糖尿病足累及的部位、组织的血流灌注情况、局部组织对感染的易感性、创口的愈合能力等是影响选择糖尿病足截肢方式和方法的重要因素。截肢后仍要重视糖尿病的综合治疗,防止截肢平面的进一步上升。     

糖尿病足截肢的29例分析

糖尿病足（ＤｉａｂｅｔｉｃＦｏｔ，ＤＦ）是糖尿病的常见并发症之一，严重者需要截趾截肢。我院于１９８７年１０月～１９９５年１０月共收治糖尿病足患者截肢２９例，报告如下。１临床资料１１一般资料本组２９例，男１５例，女１４例，年龄４５～８２岁，平均６７?..     

糖尿病足的手术截肢治疗

目的探讨糖尿病足的手术截肢治疗方式。方法通过对34例晚期糖尿病足病人截肢治疗,包括小腿截肢24例,经足截肢10例,手术后控制血糖,改善局部循环,积极处理残端疼痛等。结果术后平均随访8个月(3~16个月),残端完全愈合者28例,占82%。结论对于糖尿病足的治疗,采用截肢手术虽然迫不得已,但可以提高病人生存率,改善生存质量。     

Salvage of major amputation stumps of the lower extremity with latissimus dorsi free flaps

In some severe lower limb injuries, the level of bone trauma enables preservation of the knee joint or adequate length of the femoral stump only if the soft tissues can be reconstructed over the exposed bone. The options for soft-tissue reconstruction of an amputation stump are to use a flap from the amputated distal part, a local flap possibly after tissue expansion or a free flap. To preserve an adequate length of stump we reconstructed 10 stumps with latissimus dorsi free flaps: above the knee in one patient and below the knee in nine. The reconstructions were done during an acute post-traumatic phase in five and for late problems with the stump in four patients. In one patient the reconstruction was done nine weeks after a below-knee amputation for ischaemic necrosis after septicaemia. All flaps survived, but the venous anastomosis had to be revised in three patients in the early postoperative period. All patients regained adequate ambulation for their daily activities. The flap was secondarily debulked in three patients. Every effort should be made to preserve an adequate stump length, particularly in young patients with crushing injuries of the extremities and when there is severe or recurrent late stump ulceration. A latissimus dorsi musculocutaneous soft-tissue reconstruction is a reliable and durable option for stump defects.     

Amputation and rehabilitation

Most lower limb amputations in the UK are performed in order to treat peripheral arterial disease and its complications. Amputations are usually classified as minor, which includes toe and partial foot amputations, or major, when most of the limb is removed. The principles of selecting amputation level are considered and the importance of optimization of the patient's general medical status is stressed. Most patients requiring amputations have significant comorbidities and amputation carries an appreciable anaesthetic risk. The minor amputations include toe and ray amputations, transmetatarsal and mid-foot amputations. Ankle-level amputations, such as Syme's amputation, are rarely indicated and it is difficult to fit prostheses to these stumps. Below-knee and above-knee amputations are the most commonly performed major amputations. Below-knee amputations may be carried out using either a long posterior flap or skewed flaps. Skewed flaps may be preferred when the posterior skin is of poor quality, and produce a cylindrical stump well suited for limb fitting. Through-knee and hip disarticulations are also described. Successful amputation surgery, with good outcomes for the patient, requires an attention to detail and careful coordination with physiotherapy and rehabilitation departments. The aim is to produce a well-healed, pain-free stump suitable for limb fitting, in as many patients as possible.     

Amputation and rehabilitation

Most lower limb amputations in the UK are performed in order to treat peripheral arterial disease and its complications. Amputations are usually classified as minor, which includes toe and partial foot amputations, or major, when most of the limb is removed. The principles of selecting amputation level are considered and the importance of optimization of the patient's general medical status is stressed. Most patients requiring amputations have significant comorbidities and amputation carries an appreciable anaesthetic risk. The minor amputations include toe and ray amputations, transmetatarsal and mid-food amputations. Ankle-level amputations, such as Syme's amputation, are rarely indicated and it is difficult to fit prostheses to these stumps. Below-knee and above-knee amputations are the most commonly performed major amputations. Below-knee amputations may be carried out using either a long posterior flap or skewed flaps. Skewed flaps may be preferred when the posterior skin is of poor quality, and produce a cylindrical stump well suited for limb fitting. Through-knee and hip disarticulations are also described. Successful amputation surgery, with good outcomes for the patient, requires an attention to detail and careful coordination with physiotherapy and rehabilitation departments. The aim is to produce a well-healed, pain-free stump suitable for limb fitting, in as many patients as possible.     

Amputation and rehabilitation

Most lower limb amputations in the UK are performed in order to treat peripheral arterial disease and its complications. Amputations are usually classified as minor (toe and partial foot amputations) or major (when most of the limb is removed). Principles of selecting amputation level are considered and the importance of optimization of the patient's medical status is stressed. Most patients requiring amputations have significant comorbidities and amputation carries an appreciable anaesthetic risk. Minor amputations include toe and ray amputations, transmetatarsal and mid-foot amputations. Ankle-level amputations, such as Syme's amputation, are rarely indicated and it is difficult to fit prostheses to these stumps. Below-knee and above-knee amputations are the most commonly performed major amputations. Below-knee amputations may be carried out using either a long posterior flap or skewed flaps. Skewed flaps may be preferred when the posterior skin is of poor quality, and produce a cylindrical stump well-suited to limb fitting. Through-knee and hip disarticulations are also described. Successful amputation surgery, with good outcomes for the patient, requires attention to detail and careful coordination with physiotherapy and rehabilitation departments. The aim is to produce a well-healed, pain-free stump suitable for limb fitting.     

Amputation and rehabilitation

Most lower limb amputations in the UK are performed in order to treat peripheral arterial disease and its complications, or are due to diabetes. Amputations are usually classified as minor, which includes toe and partial foot amputations, or major, when most of the limb is removed. Principles of selecting amputation level are considered and importance of optimization of the patient's general medical status is stressed. Most patients requiring amputations have significant comorbidities and amputation carries an appreciable anaesthetic risk. Minor amputations include toe and ray amputations, transmetatarsal and mid-food amputations. Ankle-level amputations, such as Syme's amputation, are rarely indicated and it is difficult to fit prostheses to these stumps. Below-knee and above-knee amputations are the most commonly performed major amputations. Below-knee amputations may be carried out using either a long posterior flap or skewed flaps. Skewed flaps may be preferred when the posterior skin is of poor quality, and produce a cylindrical stump well suited for limb fitting. Through-knee and hip disarticulations are also described. Successful amputation surgery, with good outcomes for the patient, requires an attention to detail and careful coordination with physiotherapy and rehabilitation departments. The aim is to produce a well-healed, pain-free stump suitable for limb fitting.     

Amputation for Recurrent Soft Tissue Sarcoma of the Extremity: Indications and Outcome

Background: Limb salvage after primary site failure of extremity soft tissue sarcoma is a challenging problem. Amputation may be the most effective treatment option in selected patients with local recurrence. We compared the outcome of patients treated with amputation versus limb-sparing surgery (LSS) for locally recurrent extremity sarcoma.Methods: From 1982 to 2000, 1178 patients with localized primary extremity sarcoma underwent LSS. Of these, 204 (17%) developed local recurrence. Eighteen (9%) required major amputation and the remainder underwent LSS, of which 34 were selected for matched-pair analysis according to established prognostic variables. Rates of recurrence or death were estimated by the Kaplan-Meier method. Following adjustment for prognostic variables, a Mantel-Haenszel test was used to compare the outcome between the two treatment groups.Results: Patients in each group were well matched. All patients had high-grade tumors deep to the fascia. Median time to local recurrence was similar for both groups. Median follow-up was 95 months. Amputation was associated with a significant improvement in local control of disease (94% vs. 74%; P = .04). We observed no difference in disease-free (P = .48), disease-specific (P = .74), or overall survival (P = .93) between the two groups. Median postrecurrence survival was 20 months and 5-year OS was 36% for the entire study group.Conclusions: Limb-sparing treatment achieves local control in the majority of recurrent extremity sarcomas for which amputation is infrequently indicated. Amputation improves local disease control but not survival under these circumstances.     

Antibiotic Prophylaxis for the Prevention of Infection after Major Limb Amputation

BackgroundMajor limb amputation is often required by patients with a limited capacity to tolerate post-operative complications. Amputation stump infection is common and may necessitate re-amputation, potentially exposing a vulnerable patient to further serious complications. Effective antibiotic strategies should be employed to reduce wound infection after major amputation.MethodsOnline databases were searched to identify studies regarding reduction in wound infection following major limb amputation. Only four randomised studies were identified comparing antibiotic prophylaxis with control; a further three evaluated the efficacy of specific antibiotics. Study design, end-points and outcome data were recorded. The data were too heterogeneous for formal meta-analysis.ResultsProphylactic antibiotics significantly reduced rates of stump infection in all studies, and were associated with a reduced rate of re-amputation in one. Where investigated, the type of antibiotic did not affect rates of infection. In non-randomised studies, infection with methicillin resistant Staphylococcus aureus (MRSA) increased the risk of complications and post-operative death.ConclusionIt is agreed that prophylactic antibiotics are part of the standard of care for amputation surgery, and this is supported by limited, mostly historical-controlled data. Evolution of the bacterial threat means that future studies should assess the role and type of prophylaxis for patients with existing bacterial colonisation or infection.     

Amputation of the penis due to electrical burn--role of prefabricated urethra in penile reconstruction

Amputation of the penis due to electrical burns is not rare in India. There are many methods of penile reconstruction and same is true for urethral reconstruction. We describe the use of prefabricated radial fascial urethra with good results in such patients.