OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS: Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS: The changes in the McGill pain questionnaire were 38.8+/-9.0 prior to treatment and 11.8+/-3.1 following the treatment. The corresponding values for the control group were 37.2+/-7.7 and 28.5+/-10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0+/-1.5 and 2.8+/-0.8 in the ESWT group, respectively, and 7.2+/-1.4 and 5.8+/-2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm2) were not significantly different between groups (p>0.05). CONCLUSION: The study findings imply that ESWT for stump neuroma is superior to conventional therapy.
Amputation ; Amputation Stumps ; Humans ; Neuroma* ; Pain Measurement ; Shock* ; Transcutaneous Electric Nerve Stimulation ; Ultrasonography ; Visual Analog Scale

Verrucous hyperplasia appears as multiple, warty, coalescent papules arising on the distal portion of amputation stump skin, yet it displays no histological evidence of viral warts. It occurs when the chronic pressure of a poor prosthetic fit disrupts vascular and lymphatic channels, subsequently causing chronic tissue edema. We report a case of 30 year old male, with 15 year history of wearing below-the-knee prosthesis, who presented with a verrucous papule that arose at his amputation site. Histopathological findings showed hyperkeratosis, acanthosis, superficial dermal edema and dilated thick vessles oriented vertical to the skin surface. Verrucous hyperplasia with lymphedema was diagnosed on the basis of clinical and histological findings.
Adult ; Amputation Stumps* ; Amputation* ; Edema ; Humans ; Hyperplasia* ; Leg* ; Lymphedema* ; Male ; Prostheses and Implants ; Skin ; Warts

PURPOSE: To evaluate the plain radiographic findings of bone and joint changes following electrical burn. MATERIALS AND METHODS: This study involved 19 patients with 27 bone and joints regions which had sufferedelectrical injury. The most common input and output sites were, respectively, the hand(7/14) and foot (6/10).Three other sites were involved. Four cases involved osteomyelitis, and in four, amputation was performed. Weobserved bone and joint changes, changes following osteomyelitis and changes in the amputation stump. We analyzedthe difference between input and output changes, and when this was interesting, the average time of onset wasassessed. RESULTS: In bone and joint changes following electrical burn, the most frequent radiographic findingwas joint contracture (n=16). Other findings included osteolysis (n=8), articular abnormalites (n=6), periostitis(n=5), fracture (n=5), acro-osteolysis (n=2), and heterotopic bone formation (n=2). In cases involvingosteomyelitis(n=4), aggravation of underlying bone changes was noted. CONCLUSION: In electrical burn, variouschanges were noted in bone and joints, and input injury was more severe than that of output.
Acro-Osteolysis ; Amputation ; Amputation Stumps ; Burns* ; Contracture ; Foot ; Humans ; Joints* ; Osteogenesis ; Osteolysis ; Osteomyelitis

Amputation of the lower extremities followed by the use of an artificial leg is very common. However, malignancy arising in an amputation stump is an extremely rare event. In this report, we describe a case of squamous cell carcinoma arising in the amputation stump of a 56-year-old Korean man. To the best of our knowledge, similar cases have not been previously reported in Korea.
Amputation Stumps ; Amputation ; Artificial Limbs ; Carcinoma, Squamous Cell ; Epithelial Cells ; Humans ; Korea ; Lower Extremity ; Middle Aged

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wound. In cases of inevitable extremity amputation, the transfer of pedicled flap from the amputed part is possible. In such substance, it is possible to obtain the pedicled fillet flap from the amputed limb to provide stump coverage. We experienced two cases of below-knee amputation due to severe flame burn which the stump was covered with island pedicled sole-fillet flap.
Amputation Stumps* ; Amputation* ; Burns ; Extremities ; Knee* ; Lower Extremity ; Surgical Flaps ; Wounds and Injuries

The goal of surgery in fingertip amputation is to restore finger length, preserve function and at the same time provide cosmetic acceptability. Treatment options are varied and can range from simple suturing of the stump to microvascular replantation surgery. We report three cases of fingertip amputations in one adult and two pediatric patients treated with non-microsurgical replantation of the fingertip using the palmar "pocket" technique.

Human ; Male ; Female ; Adult ; Young Adult ; Adolescent ; Child ; Goals ; Replantation ; Amputation Stumps ; Amputation

During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps. The sizes of the defects in the stumps were 4x16 cm and 5x5 cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was 5x18 cm for case 1 and 18x10 cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week. Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.
Amputation ; Amputation Stumps ; Drainage ; Humans ; Hyperemia ; Knee ; Knee Joint ; Necrosis ; Patella ; Thigh

Verrucous hyperplasia shows multiple warty like lesion on the amputation stump, but the pathologic findings of viral verrucae has not been discovered. A verrucous plaque on the amputation stump of the right leg was found in 31-year-old man. He had suffered from a traumatic amputation of right leg since 8 years ago. A leg prosthesis had been worn since that time. Histopathologic findings shows hyperkeratosis, acanthosis, papillomatosis, superficial dermal edema and dilated thick-walled venules oriented vertical to the skin surface. Verrucous hyperplasia was diagnosed with lymphedema on the basis of clinical and histological findings.
Adult ; Amputation Stumps* ; Amputation* ; Amputation, Traumatic ; Artificial Limbs ; Edema ; Humans ; Hyperplasia* ; Leg* ; Lymphedema* ; Papilloma ; Skin ; Venules ; Warts

Marjolin's ulcer is a malignant lesion, which arises in a chronic wound. When squamous cell carcinoma occurs in Marjolin's ulcer, the prognosis is known to be worse than that of cutaneous squamous cell carcinoma, due to other etiologies. A 56-year-old male who was diagnosed as chronic osteomyelitis was recommended for a surgical amputation of the left lower leg. After amputation, the histology of chronic ulcer revealed squamous cell carcinoma. In a few months period, multiple suppurative ulcers and nodules appeared near the amputation stump, as well as the proximal sites of the left leg, which appeared to spread rapidly. Biopsy of a representative lesion and positron emission tomography-computed tomography revealed a metastatic squamous cell carcinoma and malignant lymphadenopathy. Aggressive amputation without appropriate preoperative evaluation to detect the locoregional metastasis may be an inadequate option of the treatment for the patient due to a rapid spread of cancer metastasis, which may happen immediately after an amputation. Therefore, it is important to obtain a thorough preoperative evaluation of recalcitrant ulcer from osteomyelitis before the decision to undergo an amputation.
Amputation ; Amputation Stumps ; Biopsy ; Carcinoma, Squamous Cell ; Electrons ; Humans ; Leg ; Lymphatic Diseases ; Male ; Middle Aged ; Neoplasm Metastasis ; Osteomyelitis ; Prognosis ; Ulcer

A study of continuous postoperative regional analgesia by nerve sheath block for limb amputation is presented. The authors reviewed 65 patients with amputation at the level proximal to the wrist or ankle. 15 patients of which were managed with continuous postoperative regional analgesia (CPRA) by nerve sheath block. At the time of exposure of nerve trunk during amputation, a catheter was introduced directy into the transected nerve sheath through a seperated stab wound, then infuse 0.5% bupivacaine 5ml prior to wound closure and postoperatively at the rate of 2 ml/4~6 hours for 3~4 days. The results were as follows : 1) Effective amputation stump analgesia was obtained, significantly reducing the need for narcotic analgesics. 2) 46 (70%) patients experienced Phantom phenomena and 30 (46%) patients experienced Phantom pain, a less frequently in CPRA group. 3) Phantom pain was more commonly observed in patients with rnore severe preamputation pain. 4) There were no significant relationships between the occurence of Phantom pain and the age of amputee or the level of amputation. We concluded that continuous postoperative regional analgesia by nerve sheath block significantly reduced the narcotic requirements in patients with ampotation surgeries.
Amputation Stumps ; Amputation* ; Amputees ; Analgesia* ; Ankle ; Bupivacaine ; Catheters ; Extremities* ; Humans ; Narcotics ; Phantom Limb ; Wounds and Injuries ; Wounds, Stab ; Wrist