• 대한족부족관절학회지
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• 제15권1호
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• pp.7-12
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• 2011

Purpose: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. Materials and Methods: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. Results: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9(range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. Conclusion: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.

• Archives of Plastic Surgery
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• 제50권5호
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2003년도 춘계학술대회 논문집
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• pp.723-728
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• 2003

The physical restoration technology for lower limb amputees is being advanced as the biomechatronics is being applied to the area of rehabilitation. As the advanced prosthetics for lower limb amputees are introduced, a suitable prescription of biomechanical rehabilitation training becomes important to utilize the advanced full features of the devices. Since lower limb amputation significantly affects biomechanical balance of mosculoskeletal system for gait, an appropriate and optimal biomechanical training and exercise should be provided to rebalance the system before wearing the prostheses. Particularly, biomechanical muscular training for hip movements in the both affected and sound lower limbs is important to achieve a normal-like ambulation. However, there is no study to understand the effect of hip muscle strength on the gait performance of lower limb amputees. To understand the hip muscle strength characteristics for normal and amputated subjects, the isokinetic exercises for various ratios of concentric contraction to eccentric contraction were performed for hip flexion-extension and adduction-abduction. As a results. biomechanical isokinetic training protocols and performance measurement methodologies for lower limb amputees were developed in this study. Using the protocols and measurement methods, it has been understood that the appropriate and optimal biomechanical prescription for the rehabilitation process for lower limb amputees is important for restoring their gait ability

• 대한물리치료과학회지
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• 제12권4호
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• pp.89-97
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• 2005

Objective: The purpose of this study was to access quality of life and evaluate pre and post surgery management for persons with lower limb amputations. Method: This study was designed as a telephone survey. The subjects were patients who underwent their lower limb amputation between January 1994, and February 2005 at Asan Medical Center in seoul. sixty one of 203 subjects had granted consent and were studied. Results: The major cause of below knee amputations was vascular disease. Traumatic injuries were more common among subjects with above knee amputations. 93.4% of subjects were in use of prosthesis and 70.1 days were required to fit the prosthesis. 68.4% of subjects were able to ambulate with single point cane or without assistive devices. 80.3% of subjects complained phantom pain. Most subjects expressed the unsatisfactory result regarding the functional usage of prosthesis and education from hospital. Conclusion: Pre and post surgery rehabilitation program will benefit to promote better functional status and quality of life for persons with lower limb amputations.

• The Journal of Korean Physical Therapy
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• 제30권5호
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• pp.199-203
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• 2018

The number of reported cases with dual disability is increasing for the past few decades. Currently, dual disability of lower limb amputation and motor weakness after stroke became a strong issue in public concern. The functional levels of patients have shown in the wide range from independent community ambulation to non-ambulation. Thus, it indicates that favorable outcomes for dual disability may depend upon adopted rehabilitative strategies. We present the case of a man with left below-knee amputation and severe right-sided weakness following a huge putaminal hemorrhage. He had suffered from extreme pain and misfit of the prosthetic socket and the complicated residual limb for three years prior to the stroke. Forty days post-stroke, we performed a revision surgery to resolve the complications of bony overgrowth, verrucous hyperplasia, and neuroma and applied an ankle foot orthosis (AFO). Two years post-stroke, he was able to ambulate outside his home and negotiate stairs using a cane. This is the first case with the dual disability of lower limb amputation and contralateral hemiplegia to undergo revision surgery. The results suggest that an early revision surgery and use of an AFO are crucial for achieving a higher level of mobility in such cases.

• Journal of Chest Surgery
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• 제47권1호
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• pp.66-70
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• 2014

A 10-year-old boy with arteriovenous malformation (AVM) of the right lower limb was scheduled for an amputation of the affected limb. Limb amputation was necessary because of the ineffectiveness of previous sclerotherapy and the rapid progression of AVM causing pain and heart failure. Right hip disarticulation was considered the best option to improve his quality of life. To prevent congestive heart failure and uncontrollable hemorrhage during surgery, the disarticulation was done under a partial cardiopulmonary bypass. The patient underwent surgery successfully without complications.

• 대한족부족관절학회지
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• 제21권2호
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• pp.66-69
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• 2017

Purpose: This study reports on limb amputations in diabetic patients according to gender, age, and region based on the data from the Korean Health Insurance Review & Assessment Service. Materials and Methods: The number of amputations was compared by region, age, gender, and year, as well as by femoral region, lower leg, foot, and toe in diabetic patients who received limb amputation. This analysis was performed based on the data from the Korean Health Insurance Review & Assessment Service, between January 2009 and December 2014. Results: The total number of amputations between the study period was 9,155. The number of patients who were treated at hospitals for diabetes in 2009 was 1.9 million, among which, 1,214 patients underwent amputation. In 2014, the incidence of diabetes was 1,747 in 2.58 million individuals. With this rising incidence of diabetes, the amputation of limbs due to diabetes is increasing every year. In particular, the following regions were amputated more often: femoral region, 2.3%; lower legs, 19.6%; feet, 18.1%; and toes 60.0%. Regarding gender differences, males showed a higher amputation rate than females for all body parts. With respect to region, Seoul was the highest with 30.2%, followed by Gyeonggi with 19.9%, and Busan with 8.8%. According to age, older age showed greater diabetic amputation rate. Conclusion: In accordance with the rising incidence of diabetes, the diabetic amputation is also increasing. Here, we showed that toes were amputated with the highest percentage and males had greater amputation rate than females for all body parts. Moreover, amputation rate was highest in older diabetic patients, especially for those in their seventies. Additionally, Seoul was the region with highest amputation rate.

• 대한족부족관절학회지
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• 제23권3호
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• pp.121-130
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• 2019

Purpose: To investigate the spatial distribution of diabetes-related lower limb amputations and analyze the relationship between the spatial distribution of diabetes-related lower limb amputations and regional factors. Materials and Methods: This study was performed based on the data from the Korean Health Insurance Review and Assessment Service, in 2016. The unit of analysis was the administrative districts of city·gun·gu. The dependent variable was the age- and sex-adjusted incidence of diabetes-related lower limb amputations and the regional variables were selected to represent two aspects: socioeconomic factors, and health and medical factors. Along with traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for spatial analysis. Results: The age- and sex-adjusted incidence of diabetes-related lower limb amputation varied according to region. OLS regression showed that the incidence of diabetes-related lower limb amputation had significant relationships with the health and medical factors (number of healthcare institution and doctors per 100,000 population). In GWR, the effects of regional factors were not consistent. Conclusion: The spatial distribution of the incidence of diabetes-related lower limb amputations and the effects of regional factors varied according to the regions. The regional characteristics should be considered when establishing health policy related to diabetic foot care.

• Archives of Plastic Surgery
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• 제50권2호
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• pp.188-193
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• 2023

Vascular injury following traumatic knee injury quoted in the literature ranges from 3.3 to 65%, depending on the magnitude and pattern of the injury. Timely recognition is crucial to ensure the revascularization is done within 6 to 8 hours from the time of injury to avoid significant morbidity, amputation, and medicolegal ramifications. We present a case of an ischemic limb following delayed diagnosis of popliteal artery injury after knee dislocation. Even though we have successfully repaired the popliteal artery, the evolving ischemia over the distal limb poses a reconstruction challenge. Multiple surgical debridement procedures were performed to control the local tissue infection. Free tissue transfer with chimeric latissimus dorsi flap was done to resurface the defect. However, the forefoot became gangrenous despite a free muscle flap transfer. His limb appeared destined for amputation in the vicinity of tissue and recipient vessels, but we chose to use a cross-leg free flap as an option for limb salvage.

• 대한족부족관절학회지
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• 제16권4호
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• pp.257-264
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• 2012

Purpose: The diabetic foot lesions are intractable, and aggravation often leads to amputation. None or minor amputation group was treated debridement or toe amputation and major amputation group was treated Ray, Lisfranc, Chopart, Below Knee and Above Knee amputation. We investigate the risk factors for major limb amputations among patients with diabetic foot lesion. Materials and Methods: The subjects were 73 diabetic foot lesion patients (83 diabetic foot lesions) treated at our department from January 2006 to December 2010. Non or Minor amputation group of 44 cases were treated with debridement or toe amputation. Major amputation group of 39 cases were treated with Ray, Lisfranc, Chopart, below or above Knee amputation. We investigated socioeconomic factors, diabetes mellitus related factors and wound related factors and laboratory factors. Statistical analysis was done by Students t-test, Chi-square test, Mann-Whitney's U test. Results: In our analysis, wound size, wound classification (Wagner classification, Brodsky classification), white blood cell counts, polymorphoneuclear neutrophil percentage, hemoglobin, C-reactive protein and albumin were risk factors for major amputation (p<0.05). Conclusion: Low education level, nutritional condition, premorbid activity level and progressed wound condition were observed in major amputation group compared with non or minor amputation group. In the major amputation group, higher white blood cell count, C-reactive protein level and lower albumin level were observed. Together with maintenance of adequate nutritional condition, early detection of lesions and foot care for early treatment is important. Therefore, active investigation with full risk evaluation of vascular complication is also important.