Article

OBJECTIVE: To study the outcomes of a new surgical and rehabilitation program for
initial unilateral transtibial amputation in patients with peripheral vascular
disease. The program consists of sagittal incision, rigid dressing, compression
therapy using silicone liner, and direct manufacturing prosthetic technique.
DESIGN: A prospective cohort study with 1-yr follow-up. RESULTS: Of the 217
consecutive patients with peripheral vascular disease who underwent transtibial
amputation (mean age, 77 yrs; 51% diabetic; 116 could walk before amputation),
119 (55%) were fitted with a prosthesis at a median time of 41 (range, 12-147)
days after amputation. Of the prosthetic recipients, 76 (64%) obtained good
function with the prosthesis within 6 mos. Within 1 yr, reamputation was
performed on 8.2%, and contralateral amputation was performed on 5.5%. The 90-day
mortality was 24% (53 patients). The total 1-yr mortality was 40% (86 patients):
17% among patients who received a prosthesis and 67% among those who did not
receive a prosthesis or had undergone reamputation. CONCLUSIONS: Following this
standardized surgical and rehabilitation program, prosthetic fitting was achieved
in more than half of transtibial amputees, almost two-thirds of prosthetic
recipients obtained good function, and the reamputation rate was low. Comparison
with outcomes of alternative strategies is needed.

Langue : ANGLAIS