Gritti-Stokes Amputation Research Articles

Innovations in Gritti-Stokes Amputation: A Focused Analysis of Immobile Patient Outcomes.

Background Major lower limb amputation is a surgical operation performed for different reasons, including life-threatening infection, ischemia, trauma, and tumors. This study aims to investigate the viability of Gritti-Stokes amputation as a suitable alternative for individuals with impaired mobility and peripheral vascular disease. Patients and methods This was a descriptive, retrospective, and observational study. All patients who met the criteria and underwent Gritti-Stokes amputation were included. The study had a duration of one year, commencing in December 2022 and concluding in December 2023. The data was processed using statistical software (SPSS, version 21; IBM Corp., Armonk, NY, US). Results Twenty-four patients were included. Concerning the complications, 16 patients (66.7%) did not experience any complications, while 7 patients (29.2%) had stump infections. Three of them ultimately required more extensive amputation. A phantom limb was observed in a single patient, accounting for a mere 4.2% of the total. Total of 21 patients, 87.5% reported great stability and lever motion when transitioning from bed to chair, as well as vice versa. Furthermore, wound healing was observed in 21 individuals (87.5%), encompassing both primary and secondary wound healing. Conclusion The Gritti-Stokes amputation provides patients with excellent stability and lever function to facilitate movement. The Gritti-Stokes amputation is a suitableoption for immobile and high-risk patients.

The Gritti-Stokes Amputation: Is It Still a Reliable Technique in the 21st Century? A Narrative Review.

Lower limb amputation is a common surgical procedure performed worldwide. Many individuals require amputation due to various circumstances, with amputations occurring above or below the knee. Surgeons rely on published research to determine the most appropriate technique based on intraoperative and postoperative outcomes. The Gritti-Stokes amputation (GSA) procedure, introduced in 1857, has shown positive results in terms of primary wound healing, reduced mortality rates during and after surgery, and accelerated healing and mobility. However, due to the need for highly trained surgeons and limitations in functional and cosmetic prosthesis fitting, concerns have been raised regarding its utility. Additionally, the procedure is underutilized in cases where it could potentially yield better results. This article provides a comprehensive review of the documented benefits of GSA, suitable candidate selection, limitations, various modifications, and a comparison with traditional approaches to lower limb amputation. The review is focused on evidence published in the last 100 years.

Rehabilitative outcomes with preparatory suction prostheses following traumatic Gritti-Stokes amputation: A case series.

Gritti-Stokes amputation (GSA) is a knee disarticulation variant, where the femur is transected at the level of the epicondyle and the patella is fixated to the distal end. GSA results in a long residual limb with little postoperative swelling and less potential for muscular atrophy, so stable limb volume may allow the use of seal-in suction for suspension for preparatory prostheses. The purpose of this case series was to report on the efficacy of seal-in suction preparatory prostheses for 2 adults with traumatic GSA. Between October and December of 2021, 2 participants with unilateral traumatic Gritti-Stokes amputation, who had received seal-in suction suspension for their preparatory prostheses, were recruited. Information was extracted from medical charts regarding prosthetic care and mobility at preparatory and definitive prosthesis evaluation, and participants underwent standardized measurement of their residual limb and prosthesis. Duration of preparatory prosthesis use was >6 months; neither participant reported loss of suspension nor significant complications with socket fit. Participant 1 required socket replacement because of residual limb pain secondary to osteophyte formation, and Participant 2 required component replacement because of weight gain. At definitive prosthesis evaluations, both participants were unlimited community ambulators; both successfully returned to work before provision of their definitive prostheses. Results indicate that seal-in suction suspension may be viable for preparatory prostheses among adults with traumatic GSA, but knee center height discrepancies persist. GSA may yield highly functional outcomes for adults with traumatic amputation. Further research is required to substantiate these findings.

Modified Gritti-Stokes amputation: tips and tricks.

Major amputations of the lower extremity may be required after trauma and a variety of underlying diseases such as peripheral vascular disease, diabetes, and malignancies. The goal of any major amputation is an optimal functional result with a maximum limb length in combination with optimal wound healing. The preservation of the knee joint is essential for successful rehabilitation, and this is best achieved by the Burgess below-knee amputation (BKA). Whenever a BKA is not possible, the Gritti-Stokes amputation is our first choice. This technique mainly consists of a through-knee amputation with the creation of a pedicled patella flap consisting of the patella, patellar ligament, and overlying soft tissue. After osteotomy of the distal femur and resection of the articular surface of the patella, the anterior flap is rotated in order to cover the femur defect while performing a patellofemoral arthrodesis. The aim of this paper is to describe our surgical technique and experience with GSA and to point out the important steps of this procedure. In conclusion, GSA is an excellent surgical option for patients requiring major lower limb amputations where BKA cannot be considered. Particular attention must be paid to careful preoperative evaluation and optimization of comorbidities. A meticulous surgical technique is warranted, including atraumatic tissue handling and an optimal patellofemoral arthrodesis technique.

Prosthetic fitting associated with better survival at 5 years after above-knee amputation due to vascular insufficiency.

Individuals requiring non-traumatic Gritti-Stokes amputation or mid-thigh amputation usually have multiple comorbidities that place them at high risk of mortality. To determine survival rate 5 years after Gritti-Stokes and mid-thigh amputation in individuals with vascular insufficiency and to identify the predictors of survival. We conducted a retrospective observational study including all individuals with vascular insufficiency who underwent amputation from September 2007 to December 2015 in our University Hospital. The indication for amputation was limb necrosis in 86% of cases, infection in 10%, and complications with the stump (discomfort, neuroma or scar dehiscence) in 4%. Medical records were analysed to determine factors and comorbidities. The date of death was retrieved from the national death registry at a minimum of 5 years after amputation. Cox proportional-hazard regression was used to estimate associations between factors and post-amputation survival with hazard ratios (HR) and 95% confidence intervals (CIs). We included 126 people with vascular insufficiency (83 men), mean age was 70 years [20; 97]; eighty-nine participants (71%) died during the study period. Survival rate was 68% at 1 year, 48% at 3 years and 37% at 5 years. Survival was associated with prosthetic fitting (HR 0.306 [95% CI 0.180; 0.521], p<0.001) and length of stay (HR 0.992 [95% CI 0.987; 0.997], p=0.003). Conversely, limb necrosis was associated with a lower survival rate (HR 3.801 [95% CI 1.615; 8.949], p=0.002). In a secondary multivariable analysis, Gritti-Stokes amputation was the only factor positively associated with prosthetic fitting (odds ratio 7.407 [95% CI 2.439; 22.489], p<0.001). The survival rate at 5 years after Gritti-Stokes and mid-thigh amputation in people with vascular insufficiency was 37%. Prosthetic fitting was independently associated with better survival, and Gritti-Stokes amputation was the only factor positively related to prosthetic fitting.

Prediction of muscle forces in residual limb during walking: comparison of transfemoral and Gritti–Stokes amputations

Radcliffe’s principle of lateral stabilization (Radcliffe 1955) was the theoretical basis of many socket designs. It describes the balance of the weight, generating a moment at the hip, of the ampu...

A Reevaluation of the Gritti-Stokes (Above-Knee) Amputation for the Nonambulatory Patient

To reevaluate the benefits of a Gritti-Stokes amputation (GSA), as an alternative to the traditional above-knee amputation (AKA), in patients who are nonambulatory or not a candidate for a below-knee amputation (BKA). A fish-mouth incision is fashioned below the tibial tuberosity into the popliteal crease, resulting in an anterior soft tissue flap and smaller posterior soft tissue flap. Thus the incision line will be on the posterior thigh, instead of the end of the stump. The patellar tendon is detached from the anterior tibial tuberosity, then the dissection is carried proximally behind the patellar tendon and the adjoining tendons of the vastus medialis and vastus lateralis, until the patella can be flipped over to expose the posterior patellar surface and joint capsule. The patellar's posterior surface is shaved down flat to medulla bone, with an electric small-toothed bone saw and large bur. The femur is then cleared circumferentially at its base. The foot is then placed at 90°, creating a 45-degree angle between the femur and the tibia, and the femur is then transected with a Gigli saw near the base or just above the base, depending on the size of the patellar surface area. This creates a 45-degree angle to the femur posteriorly, which allows the shaved patella to be secured to the end of the femur, with less chance of shifting. The fascia is then circumferentially closed around the patella and femur. Then, the remnant patellar tendon is sutured to the tendons of the posterior compartment. The dermis and skin are then closed in the standard tension-free manner using 2-0 interrupted vicryl sutures, followed by interrupted 2-0 nylon vertical mattress sutures. The dressing consisted of a single layer of ADAPTIC Non-Adhering Dressing to allow drainage, gauze fluffs, 6-inch kerlix, and finally a 6-inch ACE wrap was applied. The dressings are left intact for 2-3days and then replaced daily thereafter. A retrospective chart review was performed to identify patients who had undergone a GSA from January 2016 to September 2017 by a single surgeon. Estimated blood loss (EBL), operative time, and perioperative and postoperative complications were assessed. A total of 16 GSAs were performed on 15 patients by a single surgeon between January 7, 2016 and September 19, 2017. In our series, intraoperative outcomes were notable for an average EBL of 114mL, lower than the traditional AKA (average EBL: 300-500mL) with comparable operative times as short as 90min (skin incision to dressing). No transfusions were required in the GSA group (postop days: 1-4) compared with traditional AKA group which required an average of 2.1 units. Postoperative outcomes showed low complication rates. Postoperative complications were limited to 2 cases of a stump infection, which were treated with local wound care and subsequently healed completely. One patient died from septic shock secondary to pneumonia unrelated to the GSA surgery. A reevaluation of the GSA in the nonambulatory patient population is warranted in the United States as an alternative to the traditional AKA whenever possible. Our experience with a small series of GSA's has yielded promising advantages including potential for decreased blood loss and fewer complications in the postoperative period when compared with the standard AKA. Retained muscle attachments facilitate increased limb function and allow use of slide joint prosthetics, which are gaining popularity for ambulatory patients. The thickened skin and subcutaneous tissues overlying the patella, and the posterior incision have the potential benefit of protection against trauma and osteomyelitis seen with traditional AKA, in which case the open ended medullary bone is deep to the incision. We believe that for these same reasons the GSA should be considered in the nonambulatory patient as well.

Gritti-Stokes Amputation Increased Rate of Walking without Assistive Devices When Compared with Transfemoral Amputation in Trauma Patients

Gritti-Stokes Amputation Increased Rate of Walking without Assistive Devices When Compared with Transfemoral Amputation in Trauma Patients

Gritti-Stokes Amputation in the Trauma Patient: Tips and Techniques.

The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues. As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure. Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure. Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain. Use a high-speed saw to transect the femur and patella. Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures. Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture. Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion. Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes. The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium. IndicationsContraindicationsPitfalls & Challenges.

Gritti-Stokes Amputations in the Trauma Patient

The Gritti-Stokes amputation procedure is a modification of the traditional transfemoral amputation, with resection of the bone at a supracondylar femoral level and fixation of the patella to the distal part of the femur as an end-cap. Although well-established in patients with vascular compromise, no evidence exists on its use in the trauma setting. Fourteen consecutive patients who underwent Gritti-Stokes amputation and fifteen consecutive patients who underwent traditional transfemoral amputation by fellowship-trained orthopaedic traumatologists at a level-I trauma center were evaluated at more than fourteen months postoperatively. The Sickness Impact Profile (SIP) questionnaire was also administered to both patient groups at more than thirty-six months postoperatively to assess patient-reported functional outcomes. Despite the two groups not having significant differences in preoperative variables or demographics, the Gritti-Stokes group had significantly improved SIP questionnaire overall and domain scores. This procedure also left the patients with a significantly longer residual limb (an average of 46.1 cm of residual femoral length versus 34.6 cm for the transfemoral group). The Gritti-Stokes group also had a significantly increased rate of walking without assistive devices (five patients versus none in the transfemoral amputation group). The Gritti-Stokes amputation appears to be safe and beneficial when utilized in the trauma population.

Amputation de genou dérivée de la technique de Gritti-Stokes pour artériopathie chronique chez le sujet âgé : est-ce faisable et raisonnable ?

Major lower limb amputation in elderly patients is a dreaded event with high mortality and morbidity. Peripheral arterial disease is the nearly exclusive etiology. The aim of this retrospective study was to assess the feasibility of through-knee amputation, and the morbidity and mortality risk in the elderly (>65 years).From January 2000 to October 2010, 65 Gritti-Stokes through-knee amputations were performed in 58 patients (30 women, 28 men; mean age 79 years). Acute limb ischemia was the most common cause (40%). The others indications were: severe peripheral arterial disease with extensive necrotic lesions (19%), diabetic foot ulcers (15%), non-healing below-knee amputation (10%) and vascular graft infection after prosthetic lower extremity bypass surgery (6%).Overall 30-day mortality was 24% (n=14/58). Vascular morbidity was 9% (n=6/65). The mean hospital stay was 31 days (range 3 to 96). The overall healing rate was 78% (n=51/65). Conversion to above-knee amputation for failed Gritti-Stokes amputation was performed in one patient.Gritti-Stokes amputation is feasible in the elderly with an acceptable one-month mortality and a satisfactory overall healing rate. Most amputations are necessitated by complications of acute limb ischemia. For this subpopulation, Gritti-Stokes amputation should be the standard amputation level. The data collected in this study provide important information that can be useful before amputation for this population, their families and primary care physicians. Ambulation is an important postoperative goal and a multidisciplinary approach in specialized centers is required to achieve good wound healing rates.

Through-knee amputation in high-risk patients with vascular disease: Indications, complications and rehabilitation

During a 10-year period 104 patients (mean age 72 years) had 106 through-knee amputations. Indications for surgery were: limb gangrene, 67 (64 per cent); ischaemic ulceration, 22 (21 per cent); rest pain, 9; knee contractures, 6. Thirty patients had had previous unsuccessful vascular reconstructive surgery and five had had a failed femoral embolectomy. The through-knee disarticulation used lateral skin flaps. The mortality was 21 (20 per cent). Of the 83 survivors, 59 (71 per cent) underwent uncomplicated primary wound healing; 36 (43 per cent) of the survivors were unsuitable for rehabilitation on a prosthesis. The remaining 47 (57 per cent) were walking before discharge 30-130 days (mean 68 days) after amputation. Through-knee amputation is a rapid, relatively bloodless, amputation and is a useful debridement procedure. The many surgical and functional advantages, in conjunction with the recent reports of better rehabilitation compared with the above-knee or Gritti-Stokes amputation, suggests that the through-knee amputation deserves greater consideration.

Experience with the 'skew flap' below-knee amputation.

A review of 353 lower limb amputations over the last 7 years has been performed to assess the results of the skew flap myoplastic below-knee amputation which was introduced in April 1983 because of reported advantages in terms of wound healing and earlier ambulation. Comparing the first 3 1/2 year period with the second, the total number of amputations decreased by 31 per cent. The number of above-knee amputations remained similar in the two periods (82,62), whilst the number of Gritti-Stokes amputations fell from 79 to 21 (0.001 greater than P greater than 0.01). The proportion of below-knee (BK) amputations increased from 50 (23.7 per cent) to 59 (41.5 per cent) (0.01 greater than P greater than 0.025). The groups were comparable in terms of previous vascular surgery and co-existing medical conditions. The time to full stump healing was significantly shorter in the skew flap group compared with the earlier Burgess type BK amputation (P = 0.001), and there was a trend to fewer stump failures in the skew flap group. We therefore feel that the skew flap amputation gives superior results to the Burgess BK amputation in terms of healing and a lower complication rate, allowing a higher proportion of BK amputations to be performed. A prospective randomized trial of the two techniques is in hand to determine the accuracy of this hypothesis.

The Gritti-Stokes amputation in ischaemia: a review of 134 cases.

The results of 134 Gritti-Stokes amputations for ischaemia are presented. The mortality rate was 11% and healing occurred in 88%, reaffirming the good results already reported for this operation. The long term results are reviewed in an attempt to decide whether the most frequently cited criticisms of this procedure are justified. Stump pain and mobility of the patella were not major problems. The difficulties in fitting a suitable prosthesis are discussed and attention is drawn to the advantages of a new prosthesis that has been developed for this amputation.

Ｇｒｉｔｔｉ‐Ｓｔｏｋｅｓ法の小経験

The results of 9 Gritti-Stokes amputations are presented. Stump pain and mobility of the patella can be prevented by our surgical technique. The difficulties in fitting a suitable prosthesis are discussed and attention is drawn to the advantages of a new prosthesis that has been developed for this amputation.

Gritti-stokes amputation

Gritti-stokes amputation

Gritti-stokes amputation

Gritti-stokes amputation

GRITTI‐STOKES AMPUTATION FOR OBLITERATIVE ARTERIAL DISEASE ASSOCIATED WITH GANGRENE

Medical Journal of AustraliaVolume 1, Issue 17 p. 659-660 Correspondence GRITTI-STOKES AMPUTATION FOR OBLITERATIVE ARTERIAL DISEASE ASSOCIATED WITH GANGRENE First published: 01 April 1964 https://doi.org/10.5694/j.1326-5377.1964.tb114132.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume1, Issue17April 1964Pages 659-660 RelatedInformation

Clinical review of the Gritti-Stokes amputation.

Clinical review of the Gritti-Stokes amputation.