The effect of oxygen inhalation and intravenous naftidrofuryl on the transcutaneous partial oxygen pressure in ischaemic lower limbs.

The effect of oxygen inhalation at atmospheric pressure and Naftidrofuryl infusion (N) on the TCpO2 is shown. At the central control site--5 cm below the midclavicular line--oxygen inhalation produced a significant increase in TCpO2, whereas there was no change after Naftidrofuryl infusion. At the 10 cm below-knee site, there were significant rises after oxygen inhalation alone, Naftidrofuryl alone and both combined. The study was conducted on 20 patients (23 legs). It is suggested that this study can form the basis for a regimen to improve the viability of ischaemic limbs showing borderline TCpO2 readings, and increase the chances of a successful below-knee amputation.

The place of amputation in the management of the ischaemic lower limb in the dysvascular geriatric patient.

Statistics show that today the majority of amputations of the leg are peripheral vascular disease in patients over the age of 60. The stages of management are discussed and in particular a plea made for taking a balanced view of vascular salvage procedure and amputation as alternative treatments. The advantages are stressed for these patients to be treated in a unit where the resources for appropriate investigation are available and the surgeon has the support of a multi-disciplinary team. The importance of the pre- and post-amputation rehabilitation programme is discussed.

The early rehabilitation of lower limb amputees using a pneumatic walking aid.

A pneumatic walking training aid for amputees is described. It was developed by the late Biomechanical Research and Development Unit, Roehampton, from an original design by Professor Little in Australia. The walking aid has been used successfully on the majority of below-knee and through-knee patients rehabilitated in the Roehampton Walking Training School since 1976. There have been no complications that could be attributed to the use of the pneumatic walking aid.

Transcutaneous partial oxygen pressure assessment of the ischemic lower limb.

As a result of these studies, it can be concluded that the TCpO2 is a reliable indicator of the state of perfusion of the skin in both the healthy and ischemic legs and can be used to predict the healing potential if amputation is performed. The most meaningful reading is obtained at 10 centimeters below knee anteriorly. The critical value is approximately 35 millimeters of mercury, since the pO2 value for below-knee amputations performed upon most patients with a 10 centimeter below knee amputation was less than this, further surgical treatment was required, while all patients with values above this underwent successful amputation. Determination of the 10 centimeter below knee-control site ratio does not appear to provide any further advantage over the absolute 10 centimeter below knee site value. However, the control site measurement should be taken to eliminate central circulatory failure. The technique can be easily undertaken by hospital technicians or regular nursing or junior medical staff. A site reading requires an average of 35 minutes. The capital outlay is well within the capability of an average general hospital, and the running costs are negligible.

Total surface bearing self suspending above-knee sockets.

A new type of above-knee socket has been designed to provide total surface support and to dispense with ischial bearing as the primary weight bearing area. The socket is based upon the hypothesis that if the soft tissues of an above-knee stump are adequately supported in a suitably shaped container they will behave under load as an elastic solid with low stiffness. A method has been devised for taking the cast for the new type socket using an elastic sleeve as a "compliant socket". The grip of the elastic sleeve and the use of traction weights deform the stump tissues to the required shape while the cast is setting. The results of laboratory measurements of the transinterface pressures in these sockets under axial loading conditions have correlated well with the figures forecast by calculation. The new socket is now available to patients at a number of Centres in England.

A new approach to the management of wounds of the extremities. Controlled environment treatment and its derivatives.

Controlled Environment Treatment is a new approach to wound management--for the first time it provides the surgeon with the means of controlling and optimizing the wound environment for the duration of the healing period. Equipment is commercially available and the technique is now being applied internationally; the technique has been established for the treatment of limbs--application to the trunk requires further investigation and development. Spin-offs have already occurred, one being the control of certain types of lymphoedema by the patient in their own home; the other concerns the application of plaster of Paris to produce casts having significantly superior physiological characteristics using minimal manipulative skills. The former is known as Pressure Environment Treatment, the latter is known as Controlled Pressure Casting; equipment is commercially available internationally.

Post-amputation pneumatic walking aid.

A pneumatic walking training aid is described that has been developed by the Biomechanical Research and Development Unit, Roehampton, from the original design by Little. The new design has been used in the management of 87 amputations, including 44 patients over the age of 70. Ninety-four per cent of these patients were rehabilitated to walking independently on a pylon or prosthesis.