Abstract
One hundred and eleven consecutive patients undergoing below-knee amputation for end-stage limb ischemia were reviewed. Decision on the level of amputation was made mainly on clinical grounds. Univariate and multivariate analyses of the outcomes, including revision to above-knee amputation and ability to walk, were carried out for seven preoperative clinical variables related to history alone. Median age was seventy-one years old and there were 74 men. Fifty percent of the patients were diabetic, 14% had neurologic dysfunction, 17% had undergone remote revascularization, 25% had undergone contralateral lower extremity amputation, and 23% underwent unsuccessful attempt at foot salvage prior to amputation. Operative mortality was 10% and morbidity excluding wound complications was 14.5%. Wound complications not requiring further surgery occurred in 10 patients who all eventually walked with a prosthesis. Incidence of revision to above-knee amputation was 19%. Diabetics had less occurrence of this event (odds ratio 0.3, p=0.011). Twenty-five patients were lost at one-year follow-up. Sixty-two % of patients were alive at greater than one year postoperatively and 49% were able to walk with a prosthesis. Potential for rehabilitation among patients with below-knee amputation was adversely affected by preoperative neurologic dysfunction (odds ratio 11.8, p=0.003) and favored by remote lower extremity revascularization (odds ratio 0.3, p=0.04). In patients who required revision to above-knee amputations (n=21), only 38% were able to walk with a prosthesis as compared with 51% for those who did not require stump revisions (p=0.065). Interestingly, there was no effect of age detected on either survival or rehabilitation to walk. Ability to identify high-risk patients will facilitate their selection for primary above-knee amputations.
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