Prosthesis intolerance in patients with transfemoral amputation: a videocapillaroscopic study.
Videocapillaroscopy is a new technique allowing a noninvasive examination of the capillary framework of the skin by using a contact probe with magnifying lenses and a cold-light epiluminescence system. The aim of this article was to investigate, by videocapillaroscopy, the microcirculation of the skin of the stump in 70 consecutive patients with unilateral transfemoral amputation. Patients were divided into two subgroups according to their tolerance (A) or intolerance (B) to a prosthesis with an Icelandic-Swedish-New York socket. Subgroup A included 48 patients, 17 diabetic and 31 nondiabetic, and subgroup B included 22 patients, 16 diabetic and 6 nondiabetic. In subgroup B, the caliber of capillary loops was significantly larger (mean +/-standard deviation, 23.6 +/-2.04 vs. 16.2 +/-1.96 microm; P < 0.001), neoangiogenesis was significantly more frequent (82%vs. 25%, P < 0.001), and the presence of microaneurysms (64%vs. 15%, P < 0.001) and microhemorrhages (36%vs. 4%, P < 0.001) was also more frequent. Surprisingly, some such diabetes-like microvascular changes were also found in the six nondiabetic patients of subgroup B. By using multiple logistic regression analysis, intolerance to the prosthesis was significantly related to microvascular changes (P = 0.001) but not to diabetes (P = 0.601), although diabetes was unequally distributed in the two subgroups.
Macchi
Claudio
C
Department of Cardiovascular Medicine, Don Gnocchi Foundation, Florence, Italy.
Cassigoli
Silvia
S
Lova
Raffaele Molino
RM
Roccuzzo
Aurelio
A
Miniati
Benedetta
B
Ceppatelli
Simone
S
Conti
Andrea A
AA
Gensini
Gian Franco
GF
D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000672:Amputation Stumps / Q000098:blood supply; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications; D019544:Equipment Failure Analysis / Q000379:methods* / Q000592:standards; D005260:Female; D005269:Femur / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D020678:Microscopic Angioscopy / Q000379:methods* / Q000592:standards; D018715:Microscopy, Video / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012307:Risk Factors; D012867:Skin / Q000098:blood supply; D012907:Smoking / Q000009:adverse effects