title: Long-term outcomes of patients undergoing war-related amputations of the foot and ankle.
abstract: Long-term clinical and functional outcomes for patients undergoing foot and ankle amputations are not well documented. We attempted to document long-term outcomes for patients who required lower extremity amputations as a result of wounds suffered during wartime. For this study, 27 Iranian soldiers who had wounds requiring amputation of the foot and ankle were selected for follow-up. The participants' wartime medical records were reviewed, a clinical examination was performed, and each participant completed a questionnaire. Postamputation follow-up averaged 17.5 years. The most prevalent (66.6%) cause of injury was a land mine. The prevalences of different clinical symptoms reported by the amputees at the time of the last follow-up were as follows: 11 (40.7%) with phantom sensation, 6 (22.2%) with phantom pain, 12 (44.4%) with stump pain, 12 (44.4%) with back pain, 9 (33.3%) with contralateral knee pain, and 4 (14.8%) with ipsilateral knee pain; 20 (74%) reported treatment for psychological conditions. In regard to social conditions, 13 (48.1) were currently employed, or had been employed, for a number of years after the amputation; 26 (96%) had children, and all of the patients were married. The results of this observational study indicate that individuals have significant long-term pain and discomfort after war-related lower extremity amputation. Although all 27 (100%) of the amputees were able to maintain satisfactory family functioning, only 13 (48.1%) of the study participants were able to remain productively employed after undergoing amputation, and 20 (74%) reported long-term psychological problems in addition to their physical pain.
authors.affiliation: Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. Mebrahimzadeh@partners.org
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Ebrahimzadeh
authors.forename: Mohammad T
authors.initials: MT
authors.lastname: Rajabi
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000672:Amputation Stumps / Q000503:physiopathology; D016512:Ankle Injuries / Q000601:surgery*; D018771:Arthralgia / Q000209:etiology; D001416:Back Pain / Q000209:etiology; D004651:Employment; D005190:Family; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D007492:Iran; D007719:Knee Joint / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D008889:Military Personnel; D010146:Pain / Q000209:etiology; D010591:Phantom Limb / Q000209:etiology; D010808:Physical Examination; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014857:Warfare