STUMPS, AMPUTATION, DISEASES OE—STYE artificial limb, and sooner or later require conversion into a Syme—the ideal amputation stump.
Any of the tissues of which a stump is composed may give trouble and require treatment.
Scars may be painful, either in parts from nerve filament involvement or generally. Relief of pressure by suitable padding of the limb or excision of the scar or affected nerve will he required.
(b) Ulceration is due to unequal pressure of the artificial limb, and can frequently be relieved by hollowing out the socket at the point of pressure.
(c) Ischomia, if unrelieved, will lead to ulceration. It is due to the soft tissues being too short. This can be remedied by drawing down the skin with straps of sticking-plaster to a splint, or in the case of the leg to a walking calliper, or by causing oedema of the soft tissues by Thomas s passive congestion. If these methods fail, reamputation will be required.
(d) Eczema Intertrigo is due to depressed scars, the opposing skin surfaces perspiring and eczema resulting. Lead lotion on lint placed between the surfaces relieves, hut cure can only be effected by excision of the. scar and the eczematous surfaces.
Soft stumps may be reduced by pressure of an elastic bandage or by the wearing of a laced bucket or a plaster of Paris pylon. If
these methods fail, removal of a wedge of oedematous tissue is indicated.
bulbous nerve ends may be relieved by hollowing out the socket of the artificial limb, or by operation. This entails the re moval of the nerve bulb, or, better still, the removal of two inches from the continuity of the nerve trunk. This avoids any interference with the stump.
or sequestra may require removal, but before doing so X-ray examination of the stump must be undertaken.
Sinuses may be due to (a) caries or necrosis of bone, (b) fragments of metal, (c) silk ligatures, (d) presence of Bipp, or (c) to an infected tortuous track. All such cases should he X rayed, then injected with Bismuth paste and X rayed again, unless the first picture reveals clearly the cause of the trouble. The second picture should be stereoscopic, and will there fore reveal the track of the sinus and its relation to the bone.
of joints and painful joints may he remedied by splinting, tenotomy, hut often call for reamputation of the limb at a higher level.