Changing pattern of lower limb amputation for vascular disease

In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti-Strokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (chi 2 = 5.65, P less than 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.