Therapeutic and Economic Impact of a Modern Amputation Program

Abstract

The experience with 142 below-knee amputations for vascular occlusive disease and/or diabetes mellitus in 133 patients was reviewed. The program utilized 133Xe skin bloodflow measurement for the selection of amputation level, emphasized the use of the long posterior skin flap as an important part of surgical technique and employed immediate postoperative prosthesis with accelerated rehabilitation for postoperative management. The results of this program yielded a 0% postoperative mortality, 89% amputation healing and 100% prosthesis rehabilitation of all unilateral below-knee amputees and 93% rehabilitation of all bilateral below-knee amputees. The average time interval between amputation and fitting of a permanent prosthesis was 32 days. The use of 133Xe clearance as a measurement of capillary skin bloodflow for purposes of amputation level selection continues to be valid. All amputations with flows in excess of 2.6 ml/100 g tissue/min healed primarily, including the last 58 consecutive amputations. The total amputation of the 172 hospital V.A. [Veteran''s Administration] system was surveyed and a cost analysis, based on duration of post-amputation hospitalization, comparing immediate postoperative prosthesis with conventional techniques, was performed. The savings to the system, taking into account start-up and maintenance costs for a program which employs immediate postoperative prosthesis, was very high. A modern amputation program employing 133Xe clearance for amputation level selection and immediate postoperative prosthesis with accelerated rehabilitation is well justified based on reduced morbidity, negligible mortality and optimum patient prosthetic rehabilitation at a marked reduction in overall cost.