Aetiological Patterns of Major Limb Amputations and Their Complications in Zaria, Nigeria

Abstract

Background: Amputation is an unwanted but necessary ablative surgical procedure that is usually carried out as a last resort in an individual whose life is endangered by a disease condition. It is an ancient procedure that dates back to over 2500years during the time of Hippocrates. In the early
days, the procedure was carried out crudely by removing a limb rapidly from the patient without anaesthesia.Haemostasis was only achieved by dipping the stump in boiling oil or crushing. Surgical amputation has very devastating psychological, social as well as economic effects on the patient and the family. It also has a downturn play on the economy of the society as most of the victims are the young and middle aged individuals who constitute the major work force in the community.
Materials and Methods: Case records of all patients at Ahmadu Bello University teaching hospital who had amputation were retrospectively reviewed over five years. The period studied was between 2009 and 2013. The demographic data of the patients, the etiological factors
leading to the amputation, degree of tissue damage, level of amputation, the length of amputation stump and complications were studied. These complications include infection, flap necrosis, wound dehiscence and anemia.Patients included in the study were those that had major
limb amputation and have traceable records and had a minimum follow up of one year.
Results: One hundred and nineteen patients had major limb amputation. Eighty-one of them (68%) were males and 38 (31.9%), females with M:F = 2.1:1. Mean age of the patients was 35.99( 21.8) years. Seventy-nine (66.4%) of the patients were below the age of 40years and 40 (38.6%), above
40years of age. The commonest indication for amputation was post traditional Bonesetter gangrene of the limb (31.1%) followed by Diabetic foot gangrene (24.4%) and crush injury (11.8%). There were more lower limb amputations (81.7%)than upper limb amputations (18.3%). Postoperative stump wound infection was the commonest complication (26.1% of total and 44.9% of all complications) followed by anemia. There were 3(2.5%) records of mortuary.
Conclusion: Traditional bone setters' (TBS) gangrene and Diabetic foot gangrene were the commonest indications for major limb amputations in our center. Most of the amputations could have been most likely avoided if the patients with trauma presented to the hospital directly where
salvage measures would have been implemented, and diabetic foot gangrene would be prevented by close observation and institution of preventive measures. Adequate attention paid to predisposing factors will go a long way to reduce the indications for as well as the complications
of amputation.