ABC of vascular diseases. Rehabilitation of the amputee.

Abstract

A successful above knee amputation. The patient was walking on crutches within 10 days of operation. He had run eight miles a day until acute thrombosis of a popliteal aneurysm produced irreversible ischaemia. Most lower limb amputations are now done because of vascular insufficiency. In 1987, 4985 new lower limb amputees were referred to the disablement service centres (previously known as artificial limb and appliance centres) in England. Two thirds of these amputations were done for peripheral vascular disease and more than a fifth for the complications of diabetes mellitus. About 80% of the patients were over 60 years old at the time of amputation. The probleTms to be faced after amputation, therefore, are not only those of achieving independent mobility, but also of managing illnesses associated with advancing years and returning to the community. There are three important aims: * To produce a soundly healed stump and a patient who can walk. The level of amputation is therefore crucial: above the knee amputations heal readily but many patients who have them never master walking on a prosthesis. The converse is true of below knee amputations * Early rehabilitation with a prosthesis * Cost effectiveness. These may be achieved with a hospital based rehabilitation team that liaises closely with the disablement service centre, the general practitioner, and the community services.