Abstract
Introduction
Based on three previous Baumgartner books which present upper and lower extremity amputations and amputee sport individually, this German language 3rd edition print is a combined, completely revised and updated publication; a three in one creation. Its motto: ‘Amputation is the beginning and not the end’ (Sir Reginald Watson-Jones) is evident throughout the work. In translation the book title simply states ‘Amputation and Prosthetic Fitting’. The 11-chapter content, however, encompasses the entire and often complex spectrum of ministrations which are activated by partial or whole upper/lower extremity loss, its principles, practices and biopsychosocial issues.
The reader will be informed about fundamental thoughts on amputations, etiology, amputation causes and incidents, diagnostic procedures to establish the status of vascularity, the importance of choosing the most functional amputation level under the circumstances, explanations of the latest surgical approaches, principles of amputation surgery, post-operative care including procedures to improve residual limb quality, its length, weight-bearing properties and function. René Baumgartner, an orthopedic surgeon, emphasizes that the surgeon's role is not just limb ablation. A sufficient length, pain-free, weight-bearing and functional residual limb (a patient should be able to stand on his/her residual limb[s]) that will interface with maximum effectiveness with the prosthesis, requires individual reconstructive surgery. This surgical residual limb sculpturing is a prerequisite for a positive rehabilitation outcome. He records several personal achievements of innovative surgical techniques and modifications to obtain these goals. Amongst them are the ‘hidden’ foot amputation, surgical myoplastic modifications for transtibial – and transfemoral residual limbs, also revisions (and therefore revivals) of older amputation methods (Sauerbruch-Lebsche cineplasty, Krukenberg hand) and war wound healings with modern plastic and reconstructive surgical techniques. The text includes complicated cases of long term residual limb management.
Kogegei and Sibbel (lecturers at the School of Prosthetics and Orthotics in Dortmund, Germany) state: ‘Prosthetic fitting makes only sense if the device offers the amputee more advantages than disadvantages'. The authors then cover prosthetic fitting from A – alignment to Z – zooming in on the latest technology. They start with the rationale of early and immediate prosthetic fitting and finish with the definitive patient-specific prosthesis. Socket shapes and functions, fabrication principles, weight-bearing considerations and suspensions are featured. Feet, knee units and hip sections – from simple to sophisticated – are listed, analyzed and compared providing solid direction for indicated component selection. For upper extremity amputees there is a selection of terminal devices from hooks to myoelectric hands, depending on the control system. Intricate elbow units, socket characteristics and their suspension systems are evaluated and expertly pictured. The ‘best’ high tech and most expensive device is not always the best option. The choice of components for both, upper and lower extremity prostheses should always be based on the amputee's profile and needs such as health status, life style, activity level.
High value is placed on gait, gait analysis, Physio- and Ergotherapy. The physical challenge is that of safe, pain-free, comfortable mobility. Based on individual treatment plans, both, upper and lower extremity amputees will exercise body and residual limb and learn to don and doff their prosthesis. The emphasis for the leg amputee is on gait, overcoming gait deviations, walking stairs and getting up after a fall. All activities require prosthetic mobility and stability, as well as balance, coordination and reaction. Arm amputees have to concentrate enhancing their residual limb sensory perception to activate their prosthesis. To accomplish all activities of daily living assistive devices are sometimes needed to improve functional outcome. The chapter by the chief physical therapist Karst offers an abundance of examples and pictures to assist training upper and lower extremity amputees successfully.
Special attention is given to residual limb problems. They are common, vary in nature, and all have to be taken seriously. They can affect the circulation, muscles, bones, joints, skin and nerves. There maybe pain and/or phantom pain. Treatment and solutions to all are offered. All together the book provides, with contributions of several renowned team practitioners a wealth of knowledge and lifetime experiences.
The layout and appearance of the publication is clearly structured and easy to read. High quality pictures and drawings, many of them new and in colour almost throughout, are at times sequenced to better understand the progression and/or pattern of flow of treatments and procedures. A variety of tables are printed on a light blue background provide clinicians with compact information (e.g., facts and solutions or listing and matching). Most helpful are strategically placed boxed short and precise comments (also blue based) which highlight certain facts within the text. They are titled and colour flagged. They include: Note (green), Hints and Tricks (dark blue) and Risk Factors and Hazards (red).
The main focus is on the patient. It is heart-warming to note and also characteristic of Professor Baumgartner to allocate a section in the first chapter to patients (emotional impact, family, status in society, coping mechanism). Here is a Note (green flagged) that reads: “The patient is always the centre of attention – not his/her residual limb(s), nor any fascinating treatment procedure, from plastic-surgical techniques on all the way to complicated, costly prosthetic devices”. Again in the last chapter Professor Bernd Greitemann, another orthopedic surgeon, deliberates rehabilitation issues, teams, rehabilitation phases and social effects ending with the patient during follow-up care.
Professor Baumgartner recently received Honorary Membership from the German Society of Surgery in recognition for his 30 years of contributions and services to amputation surgery and particularly for his personal creative, innovative and resourceful operative methods to improve residual limbs.
Pierre Botta is a Swiss prosthetist. He developed prosthetic techniques mainly for lower extremity amputees: Socket designs for through-knee amputees, a computerized technique for transfemoral sockets and sophisticated prostheses for congenital lower limb deformities. He worked for 35 years in close cooperation with René Baumgartner.
Baumgartner and Botta prepared a remarkable state-of-the-art and much needed book. Highly recommended, its scientific, technical, clinical and hands-on approach deserves wide acceptance. It belongs into medical libraries and amputation clinics. It is a must for schools to prepare our next generation of practitioners to achieve the highest level of care possible, and to give them the base and the tools to build even higher standards of care in the future. A translation of this classic work into English would be of great benefit to everyone who takes care of amputees.
Gertrude Mensch, MCPA