This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Ellison, M. A. Articles by Kerstein, M. D. Search for Related Content PubMed Articles by Ellison, M. A. Articles by Kerstein, M. D. Social Bookmarking                         What's this?

Problem of Revision of Major Lower Extremity Amputation

From the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana

Donald L. Akers, JR

From the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana

Janet C. Rice

From the Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana

Morris D. Kerstein

From the Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana

Should one consider a primary above-the-knee (AK) amputation ignoring the benefits of rehabilitation of a below-the-knee (BK) amputation if there is a chance the BK amputation may fail? This is a retrospective study of 112 patients (42% women, 58% men) with an average age of fifty-seven years who under went conversion of a BK to AK amputation. A total of 3,731 BK amputations were performed during the same time period; thus 3% of the total required revisions. Of 29 deaths, 17 patients died of myocardial infarction and 7 second ary to cerebrovascular accident. Of the patients who died, 59% had diabetes and 100% had heart disease: 100% of the patients who died with cardiac causes had hypertension, 83% smoked, and 5% had a history of cerebrovascular acci dent. Thirty-six of the 112 (32%) patients had had a vascular reconstructive procedure previously. The mortality rate of 26% (29/112) reported in this series of patients undergoing revision of BK to AK amputation is similar to that in the reported literature for isolated primary AK amputation. The level of amputa tion was based on vascular evaluation and clinical judgment at the time of oper ation. The lack of increased morbidity and mortality should encourage surgeons to persist in doing as many BK amputations as clinically warranted to improve rehabilitation; no increased mortality occurs in the requirement for a second operative procedure.

Vascular and Endovascular Surgery, Vol. 24, No. 4, 229-234 (1990)
DOI: 10.1177/153857449002400403


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?