Lower limb amputation: striking the balance.
During a 5-year period, 210 patients (125 male: aged 43-96 years, median 76 years) had 228 primary amputations for peripheral arterial disease. Level selection was by clinical criteria, and there were 148 below-knee (BK, 65%), 72 above-knee (AK, 32%) and eight Gritti-Stokes (GS, 3%). Revision was needed in 43 (19%). The 30-day mortality was 14%. There were 69 patients who had previously undergone bypass grafting (< 30 days in 36; 30 days-1 year 20; > 1 year 13). In these there were 57% BK and 43% AK with a revision rate of 13%--no worse than in patients who had not had attempted limb salvage. Decisions about rehabilitation were made by a team of doctors, nurses and therapists. The 69 patients fitted with prosthetic limbs between 1987 and 1990 were followed up for eventual mobility (minimum 6 months). Of these patients, 81% used their prosthesis at least around the house, but only 16% achieved near normal mobility. This series fails to support the claim that failed arterial bypass surgery prejudices amputation level or healing. Despite attempts to achieve a high rate of below-knee amputation and good rehabilitation, the revision rate remains high and really good prosthesis usage remains low in these elderly patients.
Campbell
W B
WB
St Johnston
J A
JA
Kernick
V F
VF
Rutter
E A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods* / Q000401:mortality / Q000534:rehabilitation; D000672:Amputation Stumps; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001186:Artificial Limbs / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome