Occlusive vascular disease of lower limbs: diagnosis, amputation surgery and rehabilitation. A review of the Burke experience.

This review is concerned with the epidemiology of lower limb amputations, frequency and results of limbsaving procedures and the contemporary management of dysvascular amputees. National data showed no decline in the number and rates of amputations from 1981-1985, but the frequency of bypass surgery increased indicating that the problem of peripheral arterial occlusive disease is far from being resolved. Femoral/popliteal bypasses are performed twice as often as aorto/ileac procedures but failure rates are high. Based on observations of 238 amputees we noted that femoral/popliteal bypasses had the highest failure rate, particularly when performed as a last limbsaving effort. A laudable trend of preserving the knee was noted but poor stump conditions were the most important factors influencing the length of hospital stay (average 51 days). The amputee rehabilitation process is discussed along with a description of contemporary prosthetic technology. The cost effectiveness of state of the art devices for the older dysvascular amputee is questioned. The cost of amputation and rehabilitation is enormous, especially when preceded by unsuccessful arterial reconstruction. The loss of a leg is, of course, a major disaster for every individual and therefore limbsaving efforts and amputation techniques must be refined and the rehabilitation effort optimized.