The Fate of Amputees

Amputation statistics for England, Wales and Northern Ireland. Statistics and Research Division of the DHSS. London: HMSO, 1987.

McColl Report. Review of Artificial Limb and Appliance Centre Services, Volumes I and II. London: DHSS, 1986.

Cheshire N J Wolfe N. J. ABC of vascular disease. Critical limb ischaemia: Amputation or reconstruction. Br Med J 1992; 304: 312–14.

Gregory-Dean A. Amputations: Statistics and trends. Ann R Coll Surg 1991; 73: 137–42.

Dormandy J. Belcher G. Broos P. . Prospective study of 713 below-knee amputations for ischaemia and the effect of a prostacyclin analogue on healing. Br J Surg 1994; 81: 33–37.

Kelly P J James J. M. Criteria for determining the proper level of amputation in occlusive vascular disease. A review of 323 amputations. J Bone Joint Surg 1957; 39A: 883–91.

Hoar C S Torres J. Evaluation of below-the-knee amputation in the treatment of diabetic gangrene. N Engl J Med 1962; 266: 440–43.

Cameron H C Lennard-Jones J E Robinson M. P. Amputations in the diabetic. Outcome and survival. Lancet 1964; ii: 605–607.

Baddeley R M Fulford J. C. A trial of conservative amputations for lesions of the feet in diabetes mellitus. Br J Surg 1965; 52: 38–43.

Ecker M L Jacobs B. S. Lower extremity amputation in diabetic patients. Diabetes 1970; 19: 195–98.

Kihn R B Warren R. Beebe G. W. The ‘Geriatric’ amputee. Ann Surg 1972; 176: 305–14.

Robinson K. P. Long posterior flap amputation in geriatric patients with ischemic disease. Ann R Coll Surg 1976; 58: 440–51.

Mooney V. Wagner F W Waddel J. . The below-the-knee amputation for vascular disease. J Bone Joint Surg 1976; 58A: 365–68.

Finch D R MacDougal D J Tibbs D J Morris P. J. Amputation for vascular disease: The experience of a peripheral vascular unit. Br J Surg 1980; 67: 233–37.

Tripses D. Pollak E. W. Risk factors in healing of below-knee amputation. Appraisal of 64 amputations in patients with vascular disease. Am J Surg 1981; 141: 718–20.

Rush D S Huston C C Bivins B A . Operative and late mortality rates of above-knee and below-knee amputations. Am Surg 1981; 47: 36–39.

Creaney M G Chattopadhaya D K Ward A S . Doppler ultrasound in the assessment of amputation level. J R Coll Surg Edinb 1981; 26: 278–81.

Burgess E M Matsen F A Wyss G R . Segmental transcutaneous measurements of PO2 in patients requiring below-the-knee amputation for peripheral vascular insufficiency. J Bone Joint Surg 1982; 64A: 378–82.

Yamanaka M. Kwong P. K. The side-to-side flap technique in below-the-knee amputation with long stump. Clin Orthop 1985; 201: 75–79.

Ratcliff D A Clyne C A C Chant A D B . Prediction of amputation wound healing: The role of transcutaneous PO2 assessment. Br J Sure 1984; 71: 219–22.

O'Dwyer K J Edwards M. H. The association between lowest palpable pulse and wound healing in below knee amputations. Ann R Coll Surg 1985; 67: 232–34.

Holstein E. Skin perfusion pressure measured by radioisotope washout for predicting wound healing in lower limb amputation for arterial occlusive disease. Acta Orthop Scand Suppl 1985; 56 (213): 6–47.

Kay S P Moreland J R Schmitter E. Nutritional status and wound healing in lower extremity amputations. Clin Orthop 1987; 217: 253–56.

Christensen K S Klarke M. Transcutaneous oxygen measurement in peripheral occlusive disease. An indictor of wound healing in leg amputation. J Bone Joint Surg 1986; 68B: 423–26.

Dowd G. S. E. Predicting stump healing following amputation for peripheral vascular disease using the transcutaneous oxygen monitor. Ann R Coll Surg 1986; 68: 31–34.

Kazmers M. Satiani B. Evans W. E. Amputation level following unsuccessful distal limb salvage operations. Surgery 1980; 87: 683–87.

Harrison J D Southworth S. Callum K. G. Experience with the ‘skew-flap’ below-knee amputation. Br J Surg 1987; 74: 930–31.

Gregg R. O. Bypass or amputation? Concomitant review of bypass arterial grafting and major amputations. Am J Surg 1985; 149: 397–402.

Silverman D G Roberts A. Reilly C A . Fluorometric quantification of low-dose fluorescein delivery to predict amputation site healing. Surgery 1987; 101: 335–41.

Pinzur M S Gottschalk F. Smith D. . Functional outcome of below knee amputation. Clin Orthop Res 1993; 286: 247–49.

Houghton A D Taylor P R Thurlow S. . Success rates for rehabilitation of vascular amputees: Implications for preoperative assessment and amputation level. Br J Surg 1992; 79: 753–55.

Robinson K. P. Skew-flap below-knee amputation. Ann R Coll Surg 1991; 73: 155–57.

Kolind V. Follow up of lower limb amputees. Acta Orthop Scand 1974; 45: 97–104.

Jamieson M G Ruckley C. V. Amputation for peripheral vascular disease in a General Surgical Unit. J R Coll Surg Edinb 1983; 28: 46–49.

Cumming J G R Spence V A Jain A S . Fate of the vascular patient after below knee amputation. Lancet 1987; ii: 613–15.

Dormandy J A Thomas P. R. S. What is the natural history of a critically ischaemic patient with and without his leg? In: Greenhalgh R M Jamieson C W Nicolaides A N eds. Limb salvage and amputation for vascular disease. London: WB Saunders, 1988: 11–26.

Eneroth M. Persson B. M. Risk factors for failed healing in amputation for vascular disease. A prospective, consecutive study of 177 cases. Acta Orthop Scand 1993; 64: 369–72.

Falstie-Jensen N. Christensen K. S. A model of prediction of failure in amputation of the lower limb. Danish Med Bull 1990; 37: 283–86.

Cranley J J Krause R J Strasser E S Hafner C. D. Below the knee amputation for arteriosclerosis obliterans. Arch Surg 1969; 98: 77–80.

Burgess E M Romano R. Zettl J H Schrock R. D. Amputations of the leg for peripheral vascular insufficiency. J Bone Joint Surg 1971; 53: 874–90.

Chilvers A S Briggs J. Browse N L Kinmouth J. B. Below and through knee amputation in ischaemic disease. Br J Surg 1971; 58: 824–26.

Moore W. S. Determination of amputation level. Arch Surg 1973; 107: 798–802.

Barnes R W Thornhill B. Nix L. . Prediction of amputation wound healing. Arch Surg 1981; 116: 80–85.

Roon A J Moore W S Goldstone J. Below knee amputation — a modern approach. Am J Surg 1977; 134: 153–58.

Berardi R S Keonin Y. Amputations in peripheral vascular disease. Am J Surg 1978; 135: 231–34.

DeCossart L. Randall P. Turner P. Marcuson R. W. The fate of the below knee amputee. Ann R Coll Surg Engl 1983; 65: 230–32.

Evans W E Hayes J P Vermillion B. D. Effect of failed distal reconstruction on the level of amputation. Am J Surg 1990; 160: 217–20.

Dardik H. Kahn M. Sussman B. Ibrahim I. M. Influence of failed vascular bypass procedures on conversion of below knee to above knee amputation levels. Surgery 1982; 91: 64–69.

Harris J P Page S. Englund R. May J. Is the outlook of the vascular amputee improved by striving to preserve the knee? J Cardiovasc Surg 1988; 29: 741–45.

Tsang G M K Crowson M C Hickey N C Simms M. H. Failed femorocrural reconstruction does not prejudice amputation level. Br J Surg 1991; 78: 1479–81.

Taylor L M Hamre D. Dalman R L Porter J. M. Limb salvage vs amputation for critical ischaemia. Arch Surg 1991; 126: 1251–58.

Samson R H Gupta S K Scher L A Veith F. J. Level of amputation after failure of limb salvage procedures. Surg Gynecol Obstet 1982; 154: 56–58.

Sayers R D Thompson M M Varty K. . Changing trends in the management of lower limb ischaemia: A 17 year review. Br J Surg 1993; 80: 1269–73.

Cruse J. Foord R. A. A five year prospective study of 23,649 surgical wounds. Arch Surg 1973; 107: 206–10.

Kritter A. A technique for salvage of the infected diabetic gangrenous foot. Orthop Clin North Am 1973; 1: 21–30.

Sizer J S Wheelock F. C. Digital amputations in diabetic patients. Surgery 1972; 72: 980–89.

Moore W S Hall A D Lim R. C. Below the knee amputation for ischaemic gangrene. Am J Surg 1972; 124: 127–34.

Couch N P David J K Tilney N L . Natural history of the leg amputee. Am J Surg 1977; 133: 469–73.

Bell E. T. Atherosclerotic gangrene of the lower extremities in diabetic and non-diabetic persons. Am J Clin Pathol 1957; 28: 27–36.

Turnbull A R Chester J. F. Partial amputations of the foot for diabetic gangrene. Ann R Coll Surg 1988; 70: 329–31.

Williams H T G Hutchinson K. J. Gangrene of the feet in diabetics. Arch Surg 1974; 108: 609–11.

Verta M J Gross W S Van Bellen B. . Forefoot perfusion pressure and minor amputation for gangrene. Surgery 1976; 80: 729–34.

Baker W H Barnes R. W. Minor forefoot amputation in patients with low ankle pressure. Am J Surg 1977; 133: 331–32.

Byrne R L Nicholson M L Woolford T J Callum K. G. Factors influencing the healing of distal amputations performed for lower limb ischaemia. Br J Surg 1992; 79: 73–75.

Geroulakos G. May A. R. L. Transmetatarsal amputation in patients with peripheral vascular disease. Eur J Vasc Surg 1991; vmr-5: 655–58.

Sage R. Pinzur M S Cronin R. . Complications following midfoot amputation in neuropathic and dysvascular feet. J Am Podiatr Med Soc 1989; 79: 277–80.

Bailey M J Johnston C C W Yates C J P . Preoperative haemoglobin as a predictor of outcome of diabetic amputations. Lancet 1979; 28: 168–70.

Dickhaut S C DeLee J C Page C. P. Nutritional status: Importance in predicting wound healing after amputation. J Bone Joint Surg 1984; 66A: 71–75.

Houghton A. Allen A. Luff R. McColl I. Rehabilitation after lower limb amputation: A comparative study of above knee, through knee and Gritti–Stokes amputation. Br J Surg 1989; 76: 622–24.

Harris K A Van Schie L. Carroll S E . Rehabilitation potential of elderly patients with major amputations. J Cardiovasc Surg 1991; 32: 463–67.

O'Connell Gnatz S. Hemiplegia and amputation: Rehabilitation in the dual disability. Arch Phys Med 1989; 70: 451–54.

Steinberg F. Sunwoo I. Roettger R. Prosthetic rehabilitation of geriatric amputee patients: A follow-up study. Arch Phys Med Rehabil 1985; 66: 742–45.

Pohjolainen T. Alaranta H. Predictive factors of functional ability after lower-limb amputation. Ann Chir Gynaecol 1991; 80: 36–39.

Siriwardena G J A Bertrand P. V. Factors influencing rehabilitation of arteriosclerotic lower limb amputees. J Rehabil Res Dev 1991; 28: 35–44.

Pinzur M S Littooy F. Daniels J. . Multidisciplinary preoperative assessment and late function in dysvascular amputees. Clin Orthop 1992; 281: 239–43.

Hubbard W. A. Rehabilitation outcomes for elderly lower limb amputees. Aust J Physiother 1989; 35: 219–23.

Pell J P Donnan P T Fowkes F G R Ruckley C. V. Quality of life following lower limb amputation for peripheral arterial disease. Eur J Vasc Surg 1993; 7: 448–51.

Pohjolainen T. Alaranta H. Karkkainen M. Prosthetic use and functional and social outcome following major lower limb amputation. Prosthet Orthot Int 1990; 14: 75–79.

Gonzalez E G Corcoran P J Reyes R. L. Energy expenditure in below-knee amputees: Correlation with stump length. Arch Phys Med Rehabil 1974; 55: 111–19.

Datta D. Nair P N Payne J. Outcome of prosthetic management of bilateral lower limb amputees. Disabil Rehabil 1992; 14: 98–102.

Weaver P C Marshall S. A. A functional and social review of lower-limb amputees. Br J Surg 1973; 60: 732–37.

Whitehouse F W Jurgensen C. Block M. A. The later life of the diabetic amputee. Diabetes 1968; 17: 520–21.

Pollock S B Ernst C. B. Use of Doppler pressure measurement in predicting success in amputation of the leg. Am J Surg 1980; 139: 303–306.

Hagberg E. Berlin O K Renstrom P. Function after through knee compared with below knee and above knee amputation. Prosthet Orthot Int 1992; 16: 168–73.

Murdoch G. Amputation revisited. Prosthet Orthot Int 1984; 8: 8–15.

Malone J M Moor W. Heal J M Childers S. J. Rehabilitation for lower extremities amputations. Arch Surg 1981; 116: 93–98.

Pillar T. Gaspar E. Dickstein R. Physical rehabilitation of the elderly blind patient. Int Disabil Stud 1987; 12: 75–77.

Kullman L. Endres M. Rehabilitation of hemiplegic amputees. Int J Rehabil Res 1987; 10: 159–65.

Greenspun B. Harmon R. L. Rehabilitation of patients with end stage renal failure after lower extremity amputation. Arch Phys Med Rehabil 1986; 67: 336–38.

Sioson E. R. The elderly amputee with severe chronic obstructive pulmonary disease. Case reports. J Am Geriatr Soc 1990; 38: 51–52.

Jensen T. Krebs B. Nielson J. Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain 1983; 17: 243–56.

Houghton A D Nicholls G. Houghton A L Saadah E. McColl . Phantom pain: Natural history and association with rehabilitation. Ann R Coll Surg Engl 1994; 76: 22–25.

Stannard C. F. Phantom limb pain. Br J Hosp Med 1993; 50: 583–87.

Jensen T. Krebs B. Nielson J. Rasmussen P. Immediate and long-term phantom limb pain in amputees: Incidence, clinical characteristics and relationship to pre-amputation limb pain. Pain 1985; 21: 267–78.

Jensen T. Rasmussen P. Phantom pain and related phenomena after amputation. In: Wall P. Reds Melzak . Textbook of pain, 2nd edition. Edinburgh: Churchill Livingstone, 1989.

Sherman R A Sherman C J Gall N. G. A survey of current phantom limb pain treatment in the United States. Pain 1980; 8: 85–99.

Evans F. The placebo response in pain reduction. Adv Neurol 1974; 4: 289–96.

Lasagna L. Mosteller F. Von Flesinger J. Beecher H. A study of the placebo response. Am J Med 1954; 16: 770–79.

Bach S. Noreng M. Tjellden N. Phantom limb pain in amputees during the first 12 months following limb amputation after pre-operative lumbar epidural blockade. Pain 1988; 33: 297–301.

Penington G. Warmington S. Hull S. Freijah N. Rehabilitation of lower limb amputees and some implications for surgical management. Aust N Z J Surg 1992; 62: 774–79.

Fyfe N. C. M. An audit of amputation levels in patients referred for prosthetic rehabilitation. Prosthet Orthot Int 1990; 14: 67–70.

Harris W. Lower limb amputation in elderly patients. Can J Surg 1987; 30: 315.

Houghton A. Allen A. Luff R. McColl I. Rehabilitation after lower limb amputation: A comparative study of above-knee, through-knee and Gritti-Stokes amputations. Br J Surg 1989; 76: 622–24.

Kegel B. Carpenter M L Burgess E. M. Functional capabilities of lower extremity amputees. Arch Phys Med Rehabil 1978; 59: 109–20.

Cameron J U Murdoch G. Troup M. . Amputee rehabilitation. A Scottish survey. In: Kenedi P. Paul R. Hughes J. eds. Disability. London: Macmillan, 1979.

Davis W C Blanchard R S Jackson F. C. Rehabilitation of the geriatric amputee: A plea for moderation. Arch Phys Med Rehabil 1967; 48: 31–36.

Hanspal R S Fisher K. Chakrabarty B K Morton M. Roberts A. Mobility grades in amputee rehabilitation. Proceedings of SRR. Clin Rehabil 1991; vmr-5: 344.

Goldberg R. T. New trends in the rehabilitation of lower limb amputees. Rehabilitation 1984; 45: 2–11.

O'Toole D M Goldberg R T Ryan B. Functional change in vascular amputee patients: Evaluation by Barthel index, PULSES profile and ESCROW scale. Arch Phys Med Rehabil 1985; 66: 508–11.

Nissen S J Newman W. P. Factors influencing reintegration to normal living after amputation. Arch Phys Med Rehabil 1992; 73: 548–51.

Parkes C. M. Psycho-social transitions: Comparison between reactions to loss of a limb and loss of a spouse. Br J Psychiatry 1975; 127: 204–10.

Caine D. Psychological considerations affecting rehabilitation after amputation. Med J Aust 1973; 2: 818–21.

Randall G C Ewalt J R Blair H. Psychiatric reaction to amputation. JAMA 1945; 128: 645–52.

Froggatt D. Mawby R. I. Surviving an amputation. Soc Sci Med 1981; 15E: 123–28.

Thompson D M Haran D. Living with an amputation; the patient. Int Rehabil Med 1983; vmr-5: 165–69.

Goldner M. G. The fate of the second leg in the diabetic amputee. Diabetes 1960; 9: 100–103.

Greant P. Van den Brande P. Amputation in elderly and high-risk vascular patients. Ann Vasc Surg 1990; 4: 288–90.

Ebskov B. Josephsen P. Incidence of reamputation and death after gangrene of the lower extremity. Prosthet Orthop Int 1980; 4: 77–80.

Van Ross E R E Veves A. Boulton A. J. M. Foot pressure studies in unilateral diabetic amputees. Abstracts, International Society of Prosthetics and Orthotics Annual Scientific Meeting, April 1991.

Pinzur M S Perona P. Patwardhan A. Harvey R. Loading of the contralateral foot in peripheral vascular insufficiency below knee amputees. Foot Ankle 1991; 11: 368–71.

Otteman M G Stahlgren L. H. Evaluation of factors which influence mortality and morbidity following major lower extremity amputations for arteriosclerosis. Surg Gynecol Obstet 1965; 120: 1217–20.

Huston C C Bivins B A Ernst C B O'Griffin W. O. Morbid implications of above knee amputations. Arch Surg 1980; 115: 165–67.

Smith B. C. A twenty year follow up in fifty below knee amputations for gangrene in diabetics. Surg Gynecol Obstet 1956; 103: 625–30.

Amputation statistics for England, Wales and Northern Ireland 1975 to 1986. Statistics and Research Division of the DHSS. London: HMSO, 1987.

Sakuma J. Hinterbuchner C. Green R F Silber M. Rehabilitation of geriatric patients having bilateral lower extremity amputations. Arch Phys Med Rehabil 1974; 55: 101–11.

Muthu S. Limb fitting and survival in the dysvascular double above-knee amputee. J R Coll Surg Edinb 1983; 28: 157–59.

Huang C T Jackson J R Moore N B . Amputation: Energy cost of ambulation. Arch Phys Med Rehabil 1979; 60: 18–24.

Inderbitzi R. Buttiker M. Pfluger D. Nachbur B. The fate of bilateral lower limb amputees in end-stage vascular disease. Eur J Vasc Surg 1992; 6: 321–26.

McCollough N C Jennings J J Sarmiento A. Bilateral below the knee amputations in patients over fifty years of age. J Bone Joint Surg 1972; 54A: 1217–23.

Rosenberg N. Adiarte E. Bujdoso L J Backwinkel K. D. Mortality factors in major limb amputations for vascular disease: A study of 176 procedures. Surgery 1970; 67: 437–41.

Haynes I G Middleton M. D. Amputation for peripheral vascular disease: Experience of a district general hospital. Ann R Coll Surg 1981; 63: 342–44.

Mandrup-Poulson T. Jensen J. S. Mortality after major amputation following gangrene of the lower limb. Acta Orthop Scand 1982; 53: 879–84.

Barber G G McPhail N V Scobie T K . A prospective study of lower limb amputations. Can J Surg 1983; 26: 339–41.

Bunt T J Manship L L Bynoe P H Haynes J. L. Lower extremity amputation for peripheral vascular disease. A low risk operation. Am Surg 1984; 50: 581–84.

Stewart C P U Jain A S Ogston S. A. Lower limb amputee survival. Prosthet Orthot Int 1992; 16: 11–18.

Anderson A D Cummings V. Levine S L Kraus A. The use of lower extremity prosthetic limbs by elderly patients. Arch Phys Med Rehabil 1967; 48: 533–38.

Moffat L E F Rainey J B McPherson A. I. S. Major lower amputation reassessment. J R Coll Surg Edinb 1987; 26: 50–53.

Silverstein M J Kadish L. A study of amputations of the lower extremity. Surg Gynecol Obstet 1973; 137: 579–80.

Mandelberg A. Sheinfeld W. Diabetic amputations: Amputations of lower extremity in diabetes: Analysis of 128 cases. Am J Surg 1946; 71: 70–76.

Dale A W Capps W. Major leg and thigh amputations. Surgery 1959; 46: 333–42.

Lempke R E King R D Kaiser G C . Amputations for arteriosclerosis obliterans. Arch Surg 1963; 86: 406–13.

McClure J N Shippey S H Stokley P H . Lower extremity amputations in Grady Memorial Hospital. J Med Assoc Ga 1966; 55: 291–94.

Harris P L Read F. Eardley A. . The fate of elderly amputees. Br J Surg 1974; 61: 665–68.

Silbert S. Mid-leg amputations for gangrene in the diabetic. Ann Surg 1948; 127: 503–12.

Veal J. R. The prevention of pulmonary complications following thigh amputations. JAMA 1943; 121: 240.

Myers K A King R B Scott D F . Surgical treatment of the severely ischaemic leg: 1. Survival rates. Br J Surg 1978; 65: 460–64.

Silbert S. Amputation of the lower extremity in diabetes mellitus; a follow-up study of 294 cases. Diabetes 1952; 1: 297–99.

Hansson J. The leg amputee. A clinical follow-up study. Acta Orthop Scand Suppl 1964; 69: 1–104.

Barnett A J Twist E. Balfe A. Lower limb amputation in agreed hospital: A comparative review. Med J Aust 1976; 79: 14–18.

Stewart C P U Jain A. S. Cause of death of lower limb amputees. Prosthet Ortho Int 1992; 16: 129–32.

Jensen J S Tondevold E. Mortality after hip fractures. Acta Orthop Scand 1979; 50: 161–67.

Christensen S. Lower extremity amputations in the county of Aalborg 1961–1971, population study and follow-up. Acta Orthop Scand 1976; 47: 329–34.

Kallero K. S. Mortality and morbidity in patients with intermittent claudication as defined by venous occlusion plethysmography. J Chron Dis 1981; 34: 455–62.

Lindegard P. Jonsson B. Lithner F. Amputations in diabetic patients in Gotland and Umea Counties 1971–1980. Acta Med Scand 1984; 687: 89–93.