title: Need of Revision of Lower Limb Amputations in a North Indian Tertiary Care Centre.
abstract: Amputation of the extremity is a big challenge to mankind. Revision rate of primary amputations stands high despite of maximum care at tertiary care centres. The purpose of this study was to establish cause for the revision, identify preventable cause and to assess outcome of revision amputation surgery.
  
  
  METHODS
  We performed a retrospective study on lower limb revision amputations in Department of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, King George Medical University between Jan 2012 to Jan 2015. All patients of any age group and gender admitted for revision amputation were included in the study population.
  
  
  RESULTS
  A total of 32 patients who required revision amputation of lower limbs was included in the study, out of these 62.50 % were male and 37.50 % were female. Age of the patients ranged from 5 to 72 years with mean of 42 years. Most common level of initial amputation was below knee (56.25 %) followed by above knee amputation (31.25%). Most common indication for initial amputation was trauma (43.75%) followed by infection, vascular diseases, malignancy and leprosy. Poor stump formation was found to be most common indication for revision amputation (37.50%) followed by infection (25%), recurrent ulceration (18.75%), stitch abscess (6.25%), neuroma (6.25%), and necrosis (6.25%). All patients were treated successfully.
  
  
  CONCLUSIONS
  Revision amputation increases morbidity. Poor stump formation at the time of initial amputation and infection are the most common indication for revision surgery. These are the preventable causes and every effort should be made to alleviate these as well as other preventable causes.
authors.affiliation: Assistant Professor, Department of PMR, King George Medical University , Lucknow, India .
authors.forename: Dileep
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Assistant Professor, Department of Orthopaedic Surgery, King George Medical University , Lucknow, India .
authors.forename: Shailendra
authors.initials: S
authors.lastname: Singh
authors.affiliation: Assistant Professor, Department of Orthopaedic Surgery, King George Medical University , Lucknow, India .
authors.forename: Kumar
authors.initials: K
authors.lastname: Shantanu
authors.affiliation: Junior Resident, Department of Orthopaedic Surgery, King George Medical University , Lucknow, India .
authors.forename: Rahul
authors.initials: R
authors.lastname: Goyal
authors.affiliation: Assistant Professor, Department of Orthopaedic Surgery, King George Medical University , Lucknow, India .
authors.forename: Narendra Singh
authors.initials: NS
authors.lastname: Kushwaha
authors.affiliation: Associate Professor, Department of PMR, King George Medical University , Lucknow, India .
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Gupta
authors.affiliation: Professor, Department of PMR, King George Medical University , Lucknow, India .
authors.forename: V P
authors.initials: VP
authors.lastname: Sharma
authors.affiliation: Professor and Head, Department of Orthopaedic Surgery, King George Medical University , Lucknow, India .
authors.forename: Vineet
authors.initials: V
authors.lastname: Sharma
keywords: Amputation stumps; Morbidity; Rehabilitation
references.citation: J Trauma. 1991 Apr;31(4):495-500; discussion 500-1
references.pmid: 2020035
references.citation: Bull Prosthet Res. 1979 Fall;16(2):21-9
references.pmid: 519086
references.citation: Br J Surg. 1994 Nov;81(11):1596-9
references.pmid: 7827880
references.citation: Br J Surg. 1997 Apr;84(4):509-11
references.pmid: 9112903
references.citation: Ann R Coll Surg Engl. 2002 Sep;84(5):344-7
references.pmid: 12398130
references.citation: Plast Reconstr Surg. 1987 Jun;79(6):871-8
references.pmid: 3295912