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Abstract
Objectives. The study aimed to describe the current pattern and outcome of care at a tertiary hospital in Shisong-Cameroon and to compare our experience with that of other published data. Methods. This observational prospective hospital-based study was conducted over the two years of 2018 to 2019. The parameters reviewed include sociodemographic data like the age and sex of the patients, then the indications for the major limb amputation, and the complications. Results. The study was carried out on 172 files of patients aged 1year to 84years with a mean age of 32± 10.28 years. There were 124 (72.4%) patients of the male, and 48 (21.6%) patients were of the female gender. One hundred seventy-two amputations were realized with Lower limb amputations were 99 (57.7%) in the lower extremity, and 73 (42.3%) in the upper extremity. There were 16 patients (9.30%) with complications, including surgical site infection of the stump wound closely trailed by hematoma. The most significant risk factor for amputation was diabetes (38 patients, 22.09%) followed by ulcer (2 patients, 1.16%), and vascular disease (6 patients, 3.49%). Traumatic gangrene was the most frequently encountered indication for amputation n = 104 (60.47%), followed by diabetic gangrene n = (38 patients, 22.09%). Conclusion. Traumatic gangrene and other trauma-related limb conditions are the leading indications for amputation in this study. Trauma is mostly preventable, and so there is a need for continued intensification of the public campaign on-road use as a means of preventing severe limb injuries and thus reducing the consequent need for amputations.
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References
- Murwanashyaka E, Ssebuufu R, Kyamanywa P. Prevalence, Indications, Levels and Outcome Limb amputations at University Teaching Hospital-Butare in Rwanda. East and Central African Journal of Surgery 2013; 18 (2): 103-107
- Jawaid M, Ali I, Ghulam Mustafa Kaimkhani GM. Current Indications For Major Lower Limb Amputations At Civil Hospital, Karachi. Pakistani Journal of Surgery, 2008; 24, (4): 228-231
- Akiode O, Shonubi MO, Musa A, Sule G. Major limb amputations: an audit of indications in a suburban surgical practice. J Natl Med Assoc 2005; 97(1):74-8.
- Bushra E, Doumi A, Ali AJ. Major limb amputations in El Obeid Hospital, Western Sudan. Sudan Med J 2009:45(2): 65-69
- Chalya PL, Mabula JB, Dass RM, Ngayomela IH, Chandika AB, Mbelenge N et al. Major limb amputations: A tertiary hospital experience in northwestern Tanzania. Journal of Orthopedic Surgery and Research 2012, 7:18. http://www.josr-online.com/content /7/1/18
- Umaru H, Madubueze CC, Alada A, Onu CM. Limb amputations in Nigeria: The National hospital, Abuja experience. Niger J Surg Res 2015 16:11-4. Available from: http://www.njsrjournal.org/text.asp? 2015 /16/ 1/11/166884[cited Sept. 2019 12]
- Olasinde AA, Oginni LM, Bankole JO, Adegbehingbe BO, Oluwadiya KS. Indications for Amputations in Ile-Ife, Nigeria. Nigerian Journal of Medicine, 2002 July-September, Vol I J, No 3: 118 -120
- Apley AG, Solomon L. Apley's System of Orthopaedics and Fractures. 7th Ed. ELBS Butterworths. 1993: pg 168
- Mankin HJ, and Gebhardt MC. Advances in the management of bone tumors. Clinical Orthopaedics and Related Research 1985; 200:73-84
- Helfet DL, Howery T, Sanders R, Johansen K. Limb Salvage Versus amputation: Preliminary result of the mangled extremity Severity Score. Clinical Orthopaedics and Related Research 1990; 256:80
- Ogeng’o JA, and Obimbo MM, King’ori J. Pattern of limb amputation in a Kenyan rural hospital. International Orthopedics (SICOT) 2009; 33:1449–1453. DOI: 10.1007/s00264-009-0810-5
- Ephraim PL, Dillingham TR, Sector M, Pezzin LE, Mackenzie EJ. Epidemiology of limb loss and congenital limb deficiency: a review of the literature. Arch Phys Med Rehabil 2003; 84(5):747–761
- Thanni LO, and Tade AO. Extremity amputation in Nigeria—a review of indications and mortality. Surgeon 2007; 5:213–217
- Leggetter S, Chaturvedi N, Fuller J, Edmonds ME. Ethnicity and risk of diabetes-related lower extremity amputation. Arch Intern Med 2002; 162:73–78
- Rucker-Whitaker C, Feinglass J, Pearce WH. Explaining Racial variation in lower extremity amputation. A 5 year retrospective claims data and medical record review at an urban teaching hospital. Arch Surg 2003; 138:1347–1351
- Abbas AD, Musa AM. Changing pattern of extremity amputations in University of Maiduguri Teaching Hospital, Nigeria. Niger J Med 2007; 16:330–333
- Pisoh-Tangnyin C, Farikou I, Ngo Nonga B, Guifo ML, Mbah SN, Ngowe Ngowe M et al. Epidemiology of Extremity Amputations in Yaoundé, Cameroon. Health Sci. Dis. December 2010; 11 (4)
- Katchy AU, Duru N, Katchy S. Major Limb Amputations: A 5 year Retrospective Study in a Regional Trauma Centre. Nigerian Journal of Medicine, April - June, 2018; 27 (2): 277-281
- Omoke NI, Chukwu COO, Madubueze CC, Egwu AN. Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care. International Orthopedics (SICOT) 2012; 36: 613–618. DOI: 10.1007/s00264-011-1322-7
- Umaru RH, Gali B, Ali N. Role of inappropriate traditional splintage in limb amputation in Maiduguri, Nigeria. Annals of Afr Med 2004; 3(3):138–140
- Yinusa W and Ugbeye ME. Problems of amputation surgery in a developing country. Int Orthop 2003; 27(2):121–124
- Wagner FW. A classification and treatment program for diabetic, neuropathic, and dysvascular foot problems. In The American Academy of Orthopaedic Surgeons Instructional Course Lectures. Vol. 28. St. Louis, The C. V. Mosby Co., 1979, pp. 143–165.
- Ofiaeli RO. Indications, Levels and Outcome of Lower Extremity Amputations in Nnewi, Nigeria. Journal of Medical Investigation and Practice (JOMIP). 2001; 2(5): 18-21
- Paudel B, Shrestha BK, Banskota AK. Two faces of major lower limb amputations. Kathmandu University Medical Journal 2005; 3: 212-216.
- Yakubu AMI, and Mabogunje OA. Major limb Amputation in Adult, Zaria, Nigeria. J. Roy. Coll. Surg. Edinb. 1996; 41:102-104.
- Holcomba C, and Hassan S. Major limb Amputation in Northern Nigeria. British Journal of Surgery. 1996; 86:241-244.
- Akinyooha AL, Ogini LM, Adegbehingbe OO, Orimolade EA, Ogundele OJ. Causes of Limb amputations in Nigerian Children West Afr J Med 2006; 25 (4): 273 – 275
- Ogunlade SO, Alonge TO, Omololu AB, Gana JY and Salawu SA. Major limb amputation in Ibadan. African Journal of Medicine and Medical Sciences 2002; 31(4):333-336
- Hassan AW. Major limb amputations in University of Maiduguri Teaching Hospital. Medicare Journal. 1992; 5:13- 14.
- Asogwa SE. Epidemiology of Road Traffic Accident in Nigeria in Sofoluwe GO, Bennett FJ (eds): Principles and Practice of Community Health in Africa. University Press Ltd, Ibadan 1985:557-573.
- Greive AC, Lankhorst GJ. Functional outcome of lower-limb amputees: a prospective descriptive study in a general hospital. Prosthet Orthot Int 1996; 20: 79-87.
- Pernot HF, Winnubst GM, Cluitmans JJ, De Witte LP. Amputees in Limburg: Incidence, morbidity and mortality, prosthetic supply, care utilization and functional level after one year. Prosthet Orthot Int 2000; 24: 90- 96.
- Rommers GM, Vos LD, Groothoff JW, Schuiling CH, Eisma WH. Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 1997; 21: 92-9.
- Pisoh –Tangnyin C, Bengondo M, Mbuagbaw J, Lekina L, Takongmo S, Farikou I, Ngowe Ngowe M. Lower extremity diabetic surgical complications in Yaoundé – Cameroon. Health Sci. Dis 2009. 10(1).
- Lester F. Amputation in patients attending a diabetic clinic in Addis Ababa, Ethiopia. Ethiop Med J. 1995; 33: 15-20
- Criag B.P. Diabetes – related lower limp amputations in Australia. The medical journal of Australia 2000; 173: 352-354
- Ashry HR, Lavery LA, Armstrong DG. Cost of diabetes-related amputations in minorities. J Foot Ankle Sung 1998; 37: 186-90
- Nwankwo OE and Katchy AU. Surgical Limb amputation: A five year experience at Hilltop Orthopaedic Hospital. Nigerian Journal of Orthopaedics and Trauma 2004;3(2): 139-149
- Yakubu A, Muhammad I and Mabogunje OA. Major limb amputation in adults, Zaria, Nigeria. Journal of The Royal College of Surgeons of Edinburgh 1996; 2:102-104
- Alegbeleye B J. Traditional bonesetting practices in the Northwest Region of Cameroon.
- East Cent Afr J Surg. 2019 Apr; 24(1):47–60. https://dx.doi.org/10.4314/ecajs.v24i1.8
- Alegbeleye BJ. Traditional Medical Practice: An Appraisal of the Experience in Cameroon International Journal of Healthcare Sciences October 2019 - March 2020; 7 (2): 49-62.
- Kidmas AT, Nwadiaro CH and Igun GO. Lower limb amputations in Jos, Nigeria. East African Medicial Journal 2004; 81(8): 427-429.
- Onuminya JE, Obekpa PO, Ihezue HC, Ukegbu ND and Onabowale BO. Major Amputations in Nigeria: a plea to educate traditional bone setters. Tropical Doctor 2000; 30(3):133-135.
- Solagberu BA. The scope of amputations in a Nigerian Teaching Hospital. African Journal of Medical Sciences 2001; 30(3):225-227.
- Osime OC and Elusoji SO. Outcome of management of Gunshot injuries by Nigerian Traditional Doctors. Pakistan Journal of Medical Sciences 2006; 22: 316-319.
- Pezzin LE, Dillingham TR and Mackenzie J. Rehabilitation and the long term outcomes of persons with trauma-related amputations. Archives of Physical Medicine and Rehabilitation 2000; 81:292-300.
- Chalya PL, Mabula JB, Dass RM, Ngayomela IH, Chandika AB, Mbelenga N, Giloya JM. Major Limb Amputations: A tertiary hospital experience in northwestern Tanzania. Journal of Orthopaedic Surgery and Research. 2012; 7:18
- Green SA, Orthopaedic Surgeons: Inheritors of Tradition. Clinical Orthopaedics and Related Research 1999; 363:258-263.
- Anyanwu SNC. The diabetic foot: A major surgical problem in our environment. Nig J Surg 1994; 1(1):26–28
- Naaeder SB. Amputation of the lower limb in Korle–Bu Teaching Hospital, Accra. West Afr J Med 1993; 12:21–26
- Solomon C, van Rij AM, Barnett R, Packer SG, Lewis-Barned NJ. Amputations in the surgical budget. N Z Med J 1994; 107: 78-80.
- Van Houtum WH, Lavery LA. The costs of diabetes-related lower extremity amputations in the Netherlands. Diabetic Med 1995; 12: 777-81.
- Abou-Zamzam AM, Teruya TH, Killeen JD. Major lower extremity amputation in an academic vascular center. Ann Vasc Surg 2003; 17: 86-90.
- Ploeg AJ, Lardenoye JW, Vrancken Peeters MP, Breslau PJ. Contemporary series of morbidity and mortality after lower limb amputation. Eur J Vasc Endovasc Surg. 2005; 29(6):633-637.
- Urbianak JR. Replantation of amputated limbs and digits. In: Sabiston DC 11, Lyerly HK, eds. Sabiston Textbook of Surgery: The Biological Basis OF Modem Surgical Practice on CD-ROM. 15th ed. 1997.
- Axelrod TS, Buchler U. Severe complex injuries to the upper extremity: revascularization and replantation. J Hand Surg [Am]. 1991; 16:574-578.
- Bowen CVA, Beveridge J, Milliken RG et al. Rotating shaft avulsion amputations of the thumb. J Hand Surg [Am]. 1991; 16:117-119.
- Kutz JE, Jupiter JB, Tsai T-M. Lower limb replantation-a report of nine cases. Foot Ankle. 1983; 3:197-200.
- Tomaino M, Bowen V. Reconstructive surgery for lower limb salvage. Can J Surg. 1995; 38:221-228.
- O'Keeffe B, and Rout S. Prosthetic Rehabilitation in the Lower Limb. Indian J Plast Surg. 2019 Jan; 52(1): 134–143.
References
Murwanashyaka E, Ssebuufu R, Kyamanywa P. Prevalence, Indications, Levels and Outcome Limb amputations at University Teaching Hospital-Butare in Rwanda. East and Central African Journal of Surgery 2013; 18 (2): 103-107
Jawaid M, Ali I, Ghulam Mustafa Kaimkhani GM. Current Indications For Major Lower Limb Amputations At Civil Hospital, Karachi. Pakistani Journal of Surgery, 2008; 24, (4): 228-231
Akiode O, Shonubi MO, Musa A, Sule G. Major limb amputations: an audit of indications in a suburban surgical practice. J Natl Med Assoc 2005; 97(1):74-8.
Bushra E, Doumi A, Ali AJ. Major limb amputations in El Obeid Hospital, Western Sudan. Sudan Med J 2009:45(2): 65-69
Chalya PL, Mabula JB, Dass RM, Ngayomela IH, Chandika AB, Mbelenge N et al. Major limb amputations: A tertiary hospital experience in northwestern Tanzania. Journal of Orthopedic Surgery and Research 2012, 7:18. http://www.josr-online.com/content /7/1/18
Umaru H, Madubueze CC, Alada A, Onu CM. Limb amputations in Nigeria: The National hospital, Abuja experience. Niger J Surg Res 2015 16:11-4. Available from: http://www.njsrjournal.org/text.asp? 2015 /16/ 1/11/166884[cited Sept. 2019 12]
Olasinde AA, Oginni LM, Bankole JO, Adegbehingbe BO, Oluwadiya KS. Indications for Amputations in Ile-Ife, Nigeria. Nigerian Journal of Medicine, 2002 July-September, Vol I J, No 3: 118 -120
Apley AG, Solomon L. Apley's System of Orthopaedics and Fractures. 7th Ed. ELBS Butterworths. 1993: pg 168
Mankin HJ, and Gebhardt MC. Advances in the management of bone tumors. Clinical Orthopaedics and Related Research 1985; 200:73-84
Helfet DL, Howery T, Sanders R, Johansen K. Limb Salvage Versus amputation: Preliminary result of the mangled extremity Severity Score. Clinical Orthopaedics and Related Research 1990; 256:80
Ogeng’o JA, and Obimbo MM, King’ori J. Pattern of limb amputation in a Kenyan rural hospital. International Orthopedics (SICOT) 2009; 33:1449–1453. DOI: 10.1007/s00264-009-0810-5
Ephraim PL, Dillingham TR, Sector M, Pezzin LE, Mackenzie EJ. Epidemiology of limb loss and congenital limb deficiency: a review of the literature. Arch Phys Med Rehabil 2003; 84(5):747–761
Thanni LO, and Tade AO. Extremity amputation in Nigeria—a review of indications and mortality. Surgeon 2007; 5:213–217
Leggetter S, Chaturvedi N, Fuller J, Edmonds ME. Ethnicity and risk of diabetes-related lower extremity amputation. Arch Intern Med 2002; 162:73–78
Rucker-Whitaker C, Feinglass J, Pearce WH. Explaining Racial variation in lower extremity amputation. A 5 year retrospective claims data and medical record review at an urban teaching hospital. Arch Surg 2003; 138:1347–1351
Abbas AD, Musa AM. Changing pattern of extremity amputations in University of Maiduguri Teaching Hospital, Nigeria. Niger J Med 2007; 16:330–333
Pisoh-Tangnyin C, Farikou I, Ngo Nonga B, Guifo ML, Mbah SN, Ngowe Ngowe M et al. Epidemiology of Extremity Amputations in Yaoundé, Cameroon. Health Sci. Dis. December 2010; 11 (4)
Katchy AU, Duru N, Katchy S. Major Limb Amputations: A 5 year Retrospective Study in a Regional Trauma Centre. Nigerian Journal of Medicine, April - June, 2018; 27 (2): 277-281
Omoke NI, Chukwu COO, Madubueze CC, Egwu AN. Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care. International Orthopedics (SICOT) 2012; 36: 613–618. DOI: 10.1007/s00264-011-1322-7
Umaru RH, Gali B, Ali N. Role of inappropriate traditional splintage in limb amputation in Maiduguri, Nigeria. Annals of Afr Med 2004; 3(3):138–140
Yinusa W and Ugbeye ME. Problems of amputation surgery in a developing country. Int Orthop 2003; 27(2):121–124
Wagner FW. A classification and treatment program for diabetic, neuropathic, and dysvascular foot problems. In The American Academy of Orthopaedic Surgeons Instructional Course Lectures. Vol. 28. St. Louis, The C. V. Mosby Co., 1979, pp. 143–165.
Ofiaeli RO. Indications, Levels and Outcome of Lower Extremity Amputations in Nnewi, Nigeria. Journal of Medical Investigation and Practice (JOMIP). 2001; 2(5): 18-21
Paudel B, Shrestha BK, Banskota AK. Two faces of major lower limb amputations. Kathmandu University Medical Journal 2005; 3: 212-216.
Yakubu AMI, and Mabogunje OA. Major limb Amputation in Adult, Zaria, Nigeria. J. Roy. Coll. Surg. Edinb. 1996; 41:102-104.
Holcomba C, and Hassan S. Major limb Amputation in Northern Nigeria. British Journal of Surgery. 1996; 86:241-244.
Akinyooha AL, Ogini LM, Adegbehingbe OO, Orimolade EA, Ogundele OJ. Causes of Limb amputations in Nigerian Children West Afr J Med 2006; 25 (4): 273 – 275
Ogunlade SO, Alonge TO, Omololu AB, Gana JY and Salawu SA. Major limb amputation in Ibadan. African Journal of Medicine and Medical Sciences 2002; 31(4):333-336
Hassan AW. Major limb amputations in University of Maiduguri Teaching Hospital. Medicare Journal. 1992; 5:13- 14.
Asogwa SE. Epidemiology of Road Traffic Accident in Nigeria in Sofoluwe GO, Bennett FJ (eds): Principles and Practice of Community Health in Africa. University Press Ltd, Ibadan 1985:557-573.
Greive AC, Lankhorst GJ. Functional outcome of lower-limb amputees: a prospective descriptive study in a general hospital. Prosthet Orthot Int 1996; 20: 79-87.
Pernot HF, Winnubst GM, Cluitmans JJ, De Witte LP. Amputees in Limburg: Incidence, morbidity and mortality, prosthetic supply, care utilization and functional level after one year. Prosthet Orthot Int 2000; 24: 90- 96.
Rommers GM, Vos LD, Groothoff JW, Schuiling CH, Eisma WH. Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 1997; 21: 92-9.
Pisoh –Tangnyin C, Bengondo M, Mbuagbaw J, Lekina L, Takongmo S, Farikou I, Ngowe Ngowe M. Lower extremity diabetic surgical complications in Yaoundé – Cameroon. Health Sci. Dis 2009. 10(1).
Lester F. Amputation in patients attending a diabetic clinic in Addis Ababa, Ethiopia. Ethiop Med J. 1995; 33: 15-20
Criag B.P. Diabetes – related lower limp amputations in Australia. The medical journal of Australia 2000; 173: 352-354
Ashry HR, Lavery LA, Armstrong DG. Cost of diabetes-related amputations in minorities. J Foot Ankle Sung 1998; 37: 186-90
Nwankwo OE and Katchy AU. Surgical Limb amputation: A five year experience at Hilltop Orthopaedic Hospital. Nigerian Journal of Orthopaedics and Trauma 2004;3(2): 139-149
Yakubu A, Muhammad I and Mabogunje OA. Major limb amputation in adults, Zaria, Nigeria. Journal of The Royal College of Surgeons of Edinburgh 1996; 2:102-104
Alegbeleye B J. Traditional bonesetting practices in the Northwest Region of Cameroon.
East Cent Afr J Surg. 2019 Apr; 24(1):47–60. https://dx.doi.org/10.4314/ecajs.v24i1.8
Alegbeleye BJ. Traditional Medical Practice: An Appraisal of the Experience in Cameroon International Journal of Healthcare Sciences October 2019 - March 2020; 7 (2): 49-62.
Kidmas AT, Nwadiaro CH and Igun GO. Lower limb amputations in Jos, Nigeria. East African Medicial Journal 2004; 81(8): 427-429.
Onuminya JE, Obekpa PO, Ihezue HC, Ukegbu ND and Onabowale BO. Major Amputations in Nigeria: a plea to educate traditional bone setters. Tropical Doctor 2000; 30(3):133-135.
Solagberu BA. The scope of amputations in a Nigerian Teaching Hospital. African Journal of Medical Sciences 2001; 30(3):225-227.
Osime OC and Elusoji SO. Outcome of management of Gunshot injuries by Nigerian Traditional Doctors. Pakistan Journal of Medical Sciences 2006; 22: 316-319.
Pezzin LE, Dillingham TR and Mackenzie J. Rehabilitation and the long term outcomes of persons with trauma-related amputations. Archives of Physical Medicine and Rehabilitation 2000; 81:292-300.
Chalya PL, Mabula JB, Dass RM, Ngayomela IH, Chandika AB, Mbelenga N, Giloya JM. Major Limb Amputations: A tertiary hospital experience in northwestern Tanzania. Journal of Orthopaedic Surgery and Research. 2012; 7:18
Green SA, Orthopaedic Surgeons: Inheritors of Tradition. Clinical Orthopaedics and Related Research 1999; 363:258-263.
Anyanwu SNC. The diabetic foot: A major surgical problem in our environment. Nig J Surg 1994; 1(1):26–28
Naaeder SB. Amputation of the lower limb in Korle–Bu Teaching Hospital, Accra. West Afr J Med 1993; 12:21–26
Solomon C, van Rij AM, Barnett R, Packer SG, Lewis-Barned NJ. Amputations in the surgical budget. N Z Med J 1994; 107: 78-80.
Van Houtum WH, Lavery LA. The costs of diabetes-related lower extremity amputations in the Netherlands. Diabetic Med 1995; 12: 777-81.
Abou-Zamzam AM, Teruya TH, Killeen JD. Major lower extremity amputation in an academic vascular center. Ann Vasc Surg 2003; 17: 86-90.
Ploeg AJ, Lardenoye JW, Vrancken Peeters MP, Breslau PJ. Contemporary series of morbidity and mortality after lower limb amputation. Eur J Vasc Endovasc Surg. 2005; 29(6):633-637.
Urbianak JR. Replantation of amputated limbs and digits. In: Sabiston DC 11, Lyerly HK, eds. Sabiston Textbook of Surgery: The Biological Basis OF Modem Surgical Practice on CD-ROM. 15th ed. 1997.
Axelrod TS, Buchler U. Severe complex injuries to the upper extremity: revascularization and replantation. J Hand Surg [Am]. 1991; 16:574-578.
Bowen CVA, Beveridge J, Milliken RG et al. Rotating shaft avulsion amputations of the thumb. J Hand Surg [Am]. 1991; 16:117-119.
Kutz JE, Jupiter JB, Tsai T-M. Lower limb replantation-a report of nine cases. Foot Ankle. 1983; 3:197-200.
Tomaino M, Bowen V. Reconstructive surgery for lower limb salvage. Can J Surg. 1995; 38:221-228.
O'Keeffe B, and Rout S. Prosthetic Rehabilitation in the Lower Limb. Indian J Plast Surg. 2019 Jan; 52(1): 134–143.