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Ulutas Med J. 2016; 2(4): 166-175

A Study of Ambulatory Function and Complications in Adult Below Knee Amputees

Amit Saraf.

Introduction: Inspite of development of new surgical techniques amputation has many complications. These complications may further be categorized into early and delayed complications. Amputation not only causes a physical disability to the patient, it also has an effect on his social economic and psychological conditions. We undertook the present study with an aim of assessing complications and ambulatory functions in below knee amputees.
Methods: 10 years study was done including a total of 174 patients. Patients were grouped into diabetics and non-diabetics based on the primary cause of amputation. Various complications which were assessed included hematoma formation, wound healing problems, infections, phantom limb/pain, contractures, etc. Ambulatory functions were assessed before surgery and at follow-ups using modified ambulatory scale by Pinzur et al 1983.
Results: 41 (28.5%) had edema of the stump. Of these patients 26 were in diabetes group. In 38 patients stump healing was prolonged with 21 patients in diabetes group and 17 patients in the non-diabetic group. 16 patients had wound dehiscence with 11 patients in diabetic group and 5 in non diabetic group. 15 (10.4%) patients developed contractures after below knee amputation, of which, 9 patients were in diabetic group and 6 were in non-diabetic group. In diabetes group, preoperatively 29 (46%) patients had grade 6 level of ambulation. In non-diabetics preoperative grade 6 was observed in 77 (95.1%) of patients. Post operatively 19 (30.2%) patients in diabetic group and 64 (79 %) patients in the non-diabetic group had grade 6 ambulatory scale. 35 in diabetic group and 44 in non diabetic group lost/ changed their job. 33 patients (78.6%) in diabetes group and 48 (62.3% ) in the non-diabetic group suffered an income loss. 34 (28.6%) had a psychological effect following below knee amputation. Of these 34, 10 patients were in the diabetic group and 24 were in the non-diabetic group.
Discussion: Haematoma formation is not significant but diabetics have a higher incidence of it in comparison to non-diabetics. Edema develops in less than one-third of the patients. Diabetics have a higher incidence of it. More than one-fifth of BK stumps gets infected, with diabetic preponderance. Wound dehiscence is common in BK amputation performed due to diabetes. There is a higher incidence of above-knee amputation after BK amputation in diabetics. Preoperative and postoperative ambulatory grade is poorer in diabetics in comparison to trauma patients. Diabetics require additional support besides using the prosthesis. Manual labor class is worst affected due to loss of job. People employed in clerical/ desk jobs have minor changes. Younger people have psychological impact commonly. The death rate is significant within one year of BK amputation and diabetics have a higher probability.

Key words: Ambulatory function, complications below knee amputees

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