A study of indications and complications of the lower limb amputations in the university teaching hospital,Lusaka,Zambia

Abstract

A study to find out the indications and major lower limb amputations was done between October 1997 and April 1999 in the University Teaching Hospital (UTH). The aims and objectives of the study was:1.To determine the indications of amputations at the University Teaching Hospital in Lusaka. 2.To identify the common comphcations encountered in these amputees.3.To identify the problems associated with management of these amputees that lead to these complications and recommend ways of reducing these complications.This was a prospective study of 54 patients who underwent major lower limb amputations. The data required for study was obtained by administering a structured questionnaire. The data was analysed using EPI-info statistical software. From this study, it was found that the commonest indication for amputation was trauma in 17 (31.5%) patients and road traffic accidents were the major contributors to this trauma group in 12 patients (22%). The second commonest was dry gangrene in 12 patients (22%) followed by tumours and diabetes in 5 patients (9%) in each case. Others were bums 3 (5.5%), infections, tumours and snake bites.Also, from the study, it was observed that the majority of the stumps healed primarily before discharge in 21 (39%). However, the commonest complication was infection in 14 patients (26.0%)) and this lead to revision of stumps in 8 patients (15%). There were 7 mortalities, e of these were related to the primary pathology such as trauma and diabetes.Of the 8 patients who had revision of stumps six had below knee amputation, one above knee and needed a high above knee and one ray amputation needed a below knee. Given the fact that the commonest indication for amputation was trauma, a Chi-square test against the outcome was done with the P value 0.0000. This was less than 0.05 and was statistically significant. This means that the general trend in the outcome in the majority of the patients is primary wound healing before the patients are discharged. However, infection of the stump was the commonest complication.