Primary closure of below-knee amputation stumps: a prospective study of sixty-two cases.
Between January 1, 1985, and December 31, 1988, we prospectively studied the outcome of 62 consecutive below-knee amputations with primary closure in 56 patients. There were 35 men and 21 women; mean age was 70 years. Above-knee amputation was performed for occlusion of the profunda femoris artery, acute thrombosis of a popliteal aneurysm with inadequate sural artery vascularity, intractable knee flexion contracture, suspended ischemia, and occasionally, when ischemia was found intraoperatively to extend proximally during below-knee amputation. Bedridden patients deemed unfit for prosthetic devices were also candidates for above-knee amputation. Fifty-four lower extremities (87%) were gangrenous and rest pain was present in eight patients (13%). Twenty-nine limbs (47%) were amputated primarily, 33 (53%) after failure of one or more revascularization procedures. Six patients had bilateral amputation. Forty patients (71%) were diabetic. Mean hospital stay was five days. Fifteen patients (27%) died during a mean follow-up period of 29 months. Eleven stumps (17.5%) required reoperation; five for postoperative infection, four for wound breakdown after a fall, and two for secondary abscess. Three secondary above-knee amputations (5%) were necessary. Of 44 below-knee amputations in diabetic patients, one had to be revised at the level of the thigh. Of 33 amputations after revascularization failure, one secondary above-knee amputation was necessary. Restoration of preischemic status was achieved after a mean of 58 days. Upon patient discharge from a rehabilitation center, 44 stumps (81%) were suitable to be fitted with prostheses.(ABSTRACT TRUNCATED AT 250 WORDS)
Aligne
C
C
Service d'Angiologie, Centre Medical de Chavanne, Saint Chamond, France.
Farcot
M
M
Favre
J P
JP
Alnashawati
G
G
De Simone
F
F
Barral
X
X
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation