Abstract
Aim: The objective of this study is to determine the incidence of indications for amputations, major amputation related complications and revision numbers in Level I trauma center; which consists burn care unit, hyperbaric oxygen unit and hand surgery department in Turkey.
Materials and Methods: Amputation procedures were retrospectively reviewed and evaluated according to the amputation levels, etiology, and demographic data. Major complications that require surgical intervention, type of surgical intervention for these complications and interval between index surgery and first complication related surgery were recorded. Re-amputations were evaluated according to interval between index and revision surgery, revision indication, and revised level.
Results: A total of 558 amputations were performed for 476 patients (367 male, 109 female) in five-year period. The most common indication of amputation was diabetic complications, 250 amputations for 215 diabetic patients (44.8%) were performed. Peripheral arterial disease and trauma were the second and third common indications. The most common indication for upper extremity amputation was trauma. The most common amputation levels were hand amputations in the upper extremity, and below-knee amputation in the lower extremity. Fifty-seven of the surgical procedures were re-amputations and the interval between index surgery and revision amputation was 5.0±15.8 months. The most common indication for revision amputation was diabetic complications. Complications that required surgical intervention were infection in 46 patients, local soft tissue necrosis in 28 patients, and wound dehiscence in 2 patients.
Conclusions: This is the first study investigating amputation etiology from high capacity hospital in capital city of Turkey that can demonstrate the whole country. The most common indications in this study were diabetic foot, PAD, and trauma as it is in developed countries. The results of this study can be the first step of multicenter epidemiological studies about amputations.
References
- Doğan A, Sungur İ, Bilgiç S, et al. Amputations in eastern Turkey (Van):a multicenter epidemiological study. Acta Orthop Traumatol Turc 2008; 42 (1): 53-8.
- Sachs M, Bojunga J, Encke A. Historical evolution of limb amputation. World J Surg 1999;23:1088-1093.
- Fitzgibbons P, Medvedev G. Functional and Clinical Outcomes of Upper Extremity Amputation. J Am Acad Orthop Surg. 2015; 23 (12): 751-60.
- Imam B, Miller WC, Finlayson HC, Eng JJ, Jarus T. Incidence of lower limb amputation in Canada. Can J Public Health. 2017;108 (4): 374-80.
- Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R: Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (3): 422-9.
- Aygan İ, Tuncay İ, Tosun N, Vural S. Amputasyonlar: nedenleri ve seviyeleri (retrospektif klinik çalışma). Artroplasti Artroskopik Cerrahi 1999; 10: 179-83.
- Nwosu C, BabalolaMO, Ibrahim MH, Suleiman SI. Major limb amputations in a tertiary hospital in North Western Nigeria. Afr Health Sci. 2017; 17 (2): 508-12.
- Beyaz S, Guler UO, Bagır GS. Factors affecting lifespan following below-knee amputation in diabetic patients. Acta Orthop Traumatol Turc. 2017; 51 (5): 393-7.
- Celikoz B, Sengezer M, Işik S, et al. Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines. Microsurgery 2005; 25: 3-14.
- Belatti DA, Phisitkul P. Declines in lower extremity amputation in the US Medicare population, 2000–2010. Foot Ankle Int 2013; 34 (7): 923–31.
- Buckley CM, O’Farrell A, Canavan RJ, Lynch AD, De La Harpe DV, Bradley CP, et al. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland. PLoS ONE 2012; 7 (7): e41492.
- Lusardi ML, Nielsen CC (Eds.). Orthotics and Prosthetics in Rehabilitation, 2nd ed. St. Louis, MO: Saunders/Elsevier, 2007.
- Rathur HM, Boulton AJ. The diabetic foot. Clin Dermatol. 2007; 25 (1): 109-20.
- Yesil S, Akinci B, Yener S, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Horm (Athens). 2009; 8 (4): 286-95. Vamos EP, Bottle A, Edmonds ME, Valabhji J, Majeed A, Millett C. Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008. Diabetes Care 2010; 33 (12): 2592–7.
- Gabel J, Jabo B, Patel S, et al. Analysis of Patients Undergoing Major Lower extremity Amputation in the Vascular Quality Initiative. Ann Vasc Surg. 2018; 46: 75-82.
- Rooke TW, Hirsch AT, Misra S, et al. ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58: 2020-45.
- Vierthaler L, Callas PW, Goodney PP, et al. Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia. J Vasc Surg 2015; 62: 655-64.
- Huseynova K, Sutradhar R, Booth GL, Huang A, Ray JG. Risk of contralateral lower limb amputation and death after initial lower limb amputation e a population based study. Heliyon. 2018; 4 (10): e00836.
- Glaser JD, Bensley RP, Hurks R, et al. Fate of the contralateral limb after lower extremity amputation. J Vasc Surg. 2013; 58 (6): 1571-7.
- Low EE, Inkellis E, Morshed S. Complications and revision amputation following trauma-related lower limb loss. Injury. 2017; 48 (2): 364-70.
- Ebskov LB. Trauma-related major lower limb amputations: an epidemiologic study. J Trauma 1994; 36 (6): 778–83.
- Atesalp AS, Erler K, Gür E, Köseoğlu E, Kırdemir V, Demiralp B. Bilateral lower limb amputations as a result of landmine injuries. Presothetics and Orthotics International. 1999 (23): 50-4.
- Chang CP, Hsiao CT, Lin CN, Fann WC. Risk factors for mortality in the late amputation of necrotizing fasciitis:a retrospective study. World J Emerg Surg. 2018 (1); 13-45.
- García Del Pozo E, Collazos J, Cartón JA, Camporro D, Asensi V. Bacterial osteomyelitis: microbiological, clinical, therapeutic,and evolutive characteristics of 344episodes. Rev Esp Quimioter. 2018 Jun; 31 (3): 217-25.
- Handford C, Thomas O, Imray CHE. Frostbite. Emerg Med Clin N Am 2017; 35: 281–99.
- Carrougher GJ, McMullen K, Mandell SP, et al. Impact of Burn-Related Amputations on Return to Work:Findings From the Burn Injury Model System National Database. J Burn Care Res. 2019; 40 (1): 21-8.
- Holm CE, Bardram C, Riecke AF, Horstmann P, Petersen MM. Implant and limb survival after resection of primary bone tumors of the lower extremities and reconstruction with mega-prostheses fifty patients followed for a mean of forteen years. Int Orthop. 2018; 42 (5): 1175-81.
- Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986; 68: 1331–7.
- Aulivola B, Hile CN, Hamdan AD, Sheahan MG, Veraldi JR, Skillman JJ, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg 2004; 139 (4): 395–9.
- Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care 2006; 29 (3): 566–70.
Abstract
Amaç: Bu çalışmanın amacı, Türkiye’deki ampütasyon endikasyonlarının insidansını, ampütasyon sebepli majör komplikasyonları ve revizyon sayılarını yanık merkezi, hiperbarik oksijen ünitesi, el cerrahisi kliniği olan birinci seviye travma merkezinde belirlemektir.
Gereç ve Yöntemler: Ampütasyonlar geriye dönük olarak incelendi ve amputasyon seviyeleri, etiyoloji ve demografik verilere göre değerlendirildi. Cerrahi gerektiren komplikasyonlar,bu cerrahilerin çeşitleri, revizyon cerrahisinin zamanı ve ilk cerrahi kaynaklı komplikasyonlar kaydedildi. Yeniden ampütasyonlar revizyon cerrahisi zamanına, revizyon endikasyonuna ve revize edilen seviyeye göre değerlendirildi.
Bulgular: Beş yıllık dönemde 476 hastaya (367 erkek, 109 kadın) toplam 558 amputasyon yapıldı. En sık amputasyon endikasyonu diyabetik komplikasyonlardı, 215 diyabetik hastaya (%44,8) 250 amputasyon uygulandı.
Periferik arter hastalığı ve travma ikinci ve üçüncü sık endikasyonlardı. Üst ekstremite amputasyonu için en yaygın endikasyon travmaydı. En sık görülen amputasyon seviyeleri üst ekstremitede yapılan el amputasyonları ve alt ekstremitede diz altı ampütasyon olarak bulundu. Cerrahi işlemlerin 57'si yeniden ampütasyondu ve ilk cerrahi ile revizyon amputasyonu arasındaki süre 5,0 ± 15,8 aydı. Revizyon ampütasyonunun en sık endikasyonu diyabetik komplikasyonlardı. Komplikasyonlar 46 hastada enfeksiyon, 28 hastada lokal yumuşak doku nekrozu ve 2 hastada yara ayrılmasıydı.
Sonuç: Bu çalışma, Türkiye'nin başkentinde bulunan yüksek kapasiteli ve tüm ülkeyi temsil edebilecek bir hastanede ampütasyon etiyolojisini araştıran ilk çalışmadır. Bu çalışmada en sık endikasyonlar, gelişmiş ülkelerde olduğu gibi diyabetik ayak, PAH ve travmadır. Bu çalışmanın sonuçları, ampütasyonlarla ilgili çok merkezli epidemiyolojik çalışmaların ilk adımı olabilir.
References
- Doğan A, Sungur İ, Bilgiç S, et al. Amputations in eastern Turkey (Van):a multicenter epidemiological study. Acta Orthop Traumatol Turc 2008; 42 (1): 53-8.
- Sachs M, Bojunga J, Encke A. Historical evolution of limb amputation. World J Surg 1999;23:1088-1093.
- Fitzgibbons P, Medvedev G. Functional and Clinical Outcomes of Upper Extremity Amputation. J Am Acad Orthop Surg. 2015; 23 (12): 751-60.
- Imam B, Miller WC, Finlayson HC, Eng JJ, Jarus T. Incidence of lower limb amputation in Canada. Can J Public Health. 2017;108 (4): 374-80.
- Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R: Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89 (3): 422-9.
- Aygan İ, Tuncay İ, Tosun N, Vural S. Amputasyonlar: nedenleri ve seviyeleri (retrospektif klinik çalışma). Artroplasti Artroskopik Cerrahi 1999; 10: 179-83.
- Nwosu C, BabalolaMO, Ibrahim MH, Suleiman SI. Major limb amputations in a tertiary hospital in North Western Nigeria. Afr Health Sci. 2017; 17 (2): 508-12.
- Beyaz S, Guler UO, Bagır GS. Factors affecting lifespan following below-knee amputation in diabetic patients. Acta Orthop Traumatol Turc. 2017; 51 (5): 393-7.
- Celikoz B, Sengezer M, Işik S, et al. Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines. Microsurgery 2005; 25: 3-14.
- Belatti DA, Phisitkul P. Declines in lower extremity amputation in the US Medicare population, 2000–2010. Foot Ankle Int 2013; 34 (7): 923–31.
- Buckley CM, O’Farrell A, Canavan RJ, Lynch AD, De La Harpe DV, Bradley CP, et al. Trends in the incidence of lower extremity amputations in people with and without diabetes over a five-year period in the Republic of Ireland. PLoS ONE 2012; 7 (7): e41492.
- Lusardi ML, Nielsen CC (Eds.). Orthotics and Prosthetics in Rehabilitation, 2nd ed. St. Louis, MO: Saunders/Elsevier, 2007.
- Rathur HM, Boulton AJ. The diabetic foot. Clin Dermatol. 2007; 25 (1): 109-20.
- Yesil S, Akinci B, Yener S, et al. Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort. Horm (Athens). 2009; 8 (4): 286-95. Vamos EP, Bottle A, Edmonds ME, Valabhji J, Majeed A, Millett C. Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008. Diabetes Care 2010; 33 (12): 2592–7.
- Gabel J, Jabo B, Patel S, et al. Analysis of Patients Undergoing Major Lower extremity Amputation in the Vascular Quality Initiative. Ann Vasc Surg. 2018; 46: 75-82.
- Rooke TW, Hirsch AT, Misra S, et al. ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58: 2020-45.
- Vierthaler L, Callas PW, Goodney PP, et al. Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia. J Vasc Surg 2015; 62: 655-64.
- Huseynova K, Sutradhar R, Booth GL, Huang A, Ray JG. Risk of contralateral lower limb amputation and death after initial lower limb amputation e a population based study. Heliyon. 2018; 4 (10): e00836.
- Glaser JD, Bensley RP, Hurks R, et al. Fate of the contralateral limb after lower extremity amputation. J Vasc Surg. 2013; 58 (6): 1571-7.
- Low EE, Inkellis E, Morshed S. Complications and revision amputation following trauma-related lower limb loss. Injury. 2017; 48 (2): 364-70.
- Ebskov LB. Trauma-related major lower limb amputations: an epidemiologic study. J Trauma 1994; 36 (6): 778–83.
- Atesalp AS, Erler K, Gür E, Köseoğlu E, Kırdemir V, Demiralp B. Bilateral lower limb amputations as a result of landmine injuries. Presothetics and Orthotics International. 1999 (23): 50-4.
- Chang CP, Hsiao CT, Lin CN, Fann WC. Risk factors for mortality in the late amputation of necrotizing fasciitis:a retrospective study. World J Emerg Surg. 2018 (1); 13-45.
- García Del Pozo E, Collazos J, Cartón JA, Camporro D, Asensi V. Bacterial osteomyelitis: microbiological, clinical, therapeutic,and evolutive characteristics of 344episodes. Rev Esp Quimioter. 2018 Jun; 31 (3): 217-25.
- Handford C, Thomas O, Imray CHE. Frostbite. Emerg Med Clin N Am 2017; 35: 281–99.
- Carrougher GJ, McMullen K, Mandell SP, et al. Impact of Burn-Related Amputations on Return to Work:Findings From the Burn Injury Model System National Database. J Burn Care Res. 2019; 40 (1): 21-8.
- Holm CE, Bardram C, Riecke AF, Horstmann P, Petersen MM. Implant and limb survival after resection of primary bone tumors of the lower extremities and reconstruction with mega-prostheses fifty patients followed for a mean of forteen years. Int Orthop. 2018; 42 (5): 1175-81.
- Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986; 68: 1331–7.
- Aulivola B, Hile CN, Hamdan AD, Sheahan MG, Veraldi JR, Skillman JJ, et al. Major lower extremity amputation: outcome of a modern series. Arch Surg 2004; 139 (4): 395–9.
- Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care 2006; 29 (3): 566–70.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 30, 2020 |
| Submission Date | January 23, 2020 |
| Published in Issue | Year 2020 |