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Distinctive features of stump volume change in a fresh lower limb amputee with Parkes-Weber syndrome.

ABSTRACT: A 23-year-old man with Parkes-Weber syndrome suffered ischaemia on the toes of his left foot with overactive high-shunting. The symptoms were refractory and persistent, and trans-tibial amputation was finally performed; all detectable active lesions that had been involved by arteriovenous shunts were removed. Marked stump swelling was found a couple of times postoperatively when compression treatment was absent. Despite excessive enlargement, conventional compression treatment using elastic bandages was effective in suppressing the enlargement rapidly and in controlling the stump volume. Additionally, 8 months postoperatively, stump enlargement has not recurred using silicone liner as compressive measures. We speculated that marked stump swelling may have been caused by postoperative temporal venous congestion due to the residual varicosities in the stump. Excessive volume change of the stump confused us and stagnated prosthetic rehabilitation. Recognition of such clinical characteristics will facilitate smooth and favourable prosthetic rehabilitation in fresh amputees with Parkes-Weber syndrome.

SUBMITTER: Yahata T

PROVIDER: S-EPMC4208113 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Distinctive features of stump volume change in a fresh lower limb amputee with Parkes-Weber syndrome.

Yahata Tetsutaro T Takeuchi Akihiko A Yoshida Shinya S Tsuchiya Hiroyuki H

BMJ case reports 20141021

A 23-year-old man with Parkes-Weber syndrome suffered ischaemia on the toes of his left foot with overactive high-shunting. The symptoms were refractory and persistent, and trans-tibial amputation was finally performed; all detectable active lesions that had been involved by arteriovenous shunts were removed. Marked stump swelling was found a couple of times postoperatively when compression treatment was absent. Despite excessive enlargement, conventional compression treatment using elastic band ...[more]

PMID: 25336554

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Project description:BackgroundMajor lower-limb amputation (LLA) predisposes patients post-operatively to a significant decline in daily-life functioning. The physical condition of amputee patients prior to surgery is significantly deteriorated due to chronic peripheral vascular disease (PVD) and diabetes, which accounts for the majority of LLAs in the adult population. A common strategy called pre-rehabilitation has been used in multiple patient populations to prepare the patient for undergoing a surgical event and to improve post-operative patient outcomes. Pre-rehabilitation might enhance the outcome of dysvascular LLA patients and reduce the high post-operative mortality rates. However, experience of experts with pre-rehabilitation and feasibility of a pre-rehabilitation program in this group remains unknown.ObjectiveTo investigate the experiences of medical professionals and researchers in the field of LLA with the use of pre-rehabilitation in general and in particular PVD patients. Additionally, the study examines their opinions regarding need for and feasibility of a pre-rehabilitation program for dysvascular patients at risk for an LLA.MethodsTwo explorative focus group discussions were organized with in total 16 experts in the field of treatment and research of LLA. Transcribed data were coded using the Atlas.ti software package. Thematic analysis with inductive approach was opted to arrange and interpret codes.ResultsThe experiences of the experts with pre-rehabilitation in dysvascular patients were scarce. The experts described dysvascular patients at risk for an LLA as a difficult group for pre-rehabilitation due to short time window prior to surgery, older age, multiple co-morbidities and lack of motivation for behavioral change. The experts concluded that a pre-rehabilitation program should focus on patients who have sufficient time in advance before the amputation for pre-rehabilitation and who are motivated to participate.ConclusionAlthough in general the effects of pre-rehabilitation are promising, pre-operative rehabilitation in dysvascular patients at risk for an LLA seems not feasible. Future research could focus on a better monitoring of dysvascular patients and the development of pre-rehabilitation in subgroups of younger dysvascular LLA patients.

Dataset Information

Distinctive features of stump volume change in a fresh lower limb amputee with Parkes-Weber syndrome.

Publications

Distinctive features of stump volume change in a fresh lower limb amputee with Parkes-Weber syndrome.

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