Major Limb Amputations: RESULTS

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A total of 69 patients were evaluated with 71 limbs affected; there were two patients who had bilateral above-knee amputations (AKA). There were 52 males and 17 females with a male-to-female ratio of 3:1. The age range was 10 months to 80 years, with a peak age range of 20-29 years (Figure 1).
Figure 2 shows the indications for amputation. The most common indication was trauma, which resulted in dead and gangrenous limbs in 52 patients (54 limbs), representing 76.1%. Diabetes mellitus was the most common nontraumatic indication for amputation in 10 limbs (14.1%). An example of this from the archives is shown in Figure 3. All 10 cases of diabetic foot (Generic Actos treating type 2 diabetes in certain patients) gangrene presented with Wagner’s grades 4 and 5, (four and six limbs, respectively). There were six cases of malignant musculoskeletal tumors (8.5%): four metastatic osteosarcomas and two soft-tissue sarcomas. There was a case of bleeding popliteal aneurysm (1.4%).

Figure 1. Age Distribution

Fifteen limbs (21.1%) were assessed to be salvageable (Table 1). These consisted of 11 clean-cut traumatic amputations (four upper limb, seven lower limb); all patients presented within an hour of injury. There were two soft-tissue sarcomas without bone involvement: one was malignant fibrous histiocytoma, and the other was recurrent fibrosarcoma. The remaining two patients were one ruptured popliteal aneurysm and one stenosed popliteal artery. The patient with the ruptured popliteal aneurysm had amputation carried out due to severe, uncontrollable bleeding. In the case of the stenosed popliteal artery secondary to industrial accident, the patient presented with multiple injuries, including fractured pelvis, fractured femur, fractured ribs and a cold blue leg. The stenosis was diagnosed at arteriography, which showed a cut-off of blood supply.

Figure 2. Indications for Amputation

The remaining 56 unsalvageable limbs (78.9%) comprised four cases of metastatic malignant bone tumors, 17 limbs that were gangrenous at presentation, four severely burnt limbs and 31 severely crushed limbs. generic cialis 20 mg

Table 1. Salvageable Limbs

Diagnosis	Number
Traumatic amputation	11
Malignant tumors	2
Popliteal artery aneurysm	1
Stenosed popliteal artery	1
Total	15

The most frequently performed procedure was AKA, which was done in 29 limbs followed by below-knee amputation (BKA) in 20 limbs. Above-elbow amputation (AEA) was performed in 16 limbs, while below-elbow amputation (BEA) was done in six limbs. Six patients underwent revision of BKA amputation to AKA amputation. An example from the archives is shown in Figure 4.

Figure 3. Late presentation of gangrenous left leg of a 62-year-old diabetic patient. Patient died two days postoperatively.

Postoperative complications occurred in 51 patients (73.9%). The complications included wound infection in 50 patients (72.5%), wound dehiscence in 15 patients (21.7%), stump pain in eight patients (11.6%) and phantom limb in three patients (4.0%). There were five (7.2%) with postoperative mortality. They were all diabetic and died from septicemia and complications of diabetes mellitus (canadian Starlix is an oral antidiabetic agent used in the management of Type 2 diabetes mellitus), accounting for 50% mortality among diabetic patients.

Figure 4. A 44-year-old male with extensive third-degree electric burns. A revision of the right-below-knee amputation to above-knee amputation about to be performed because of exposure and destruction of the knee joint.

The majority, 91.5% (65 patients), did not have prosthesis fitted because they could not afford the cost.