514
CHAPTER 30
who had a bilateral amputation above the knees performed some time after his injury.
The tragedy in this case was that he made a considerable recovery from his cord lesion,
but as a result of the amputation he was unable to sit. In two other patients with trans
verse lesions even high amputations with exarticulation of the hip joint were performed
because of penetrating pressure sores. In a case with marked spasticity of the legs the
right leg was amputated above the knee because of a sore penetrating into the knee joint.
As a result the patient developed such a profound flexion contracture of the hip that
the stump became firmly fixed to the abdomen, indeed a shocking sight. The writer has
always been strongly opposed to these mutilating procedures, carried out indiscriminately
(Guttmann, 1961).
Amputations of limbs in transverse lesions of the cord should have the same strict
indications as accepted in non-paralysed patients:
1
Vascular obstruction of a large artery resulting in stoppage of blood flow and gangrene
of the limb below the obstruction due to any acute or chronic vascular afflictions such as
thrombangiitis obliterans.
2 Severe congenital or acquired deformity of one or both legs combined with contrac-
tures. In 1959 a report was given about a 17 year old girl with spina bifida with profound
deformity of both feet who, in spite of full function of the quadriceps on both sides, since
early youth was chair-bound. Following bilateral amputation below the knees and fitting
with appropriate prostheses she was able to stand and walk for the first time in her life.
The same result was achieved in another case of spina bifida—a man aged 40 in whom,
because of profound deformity of the right foot, an amputation below the knee was
performed (Guttmann, 1959).
3 Certain compound fractures of long bones involving disruption or other severe damage
of large vessels.
4 Severe osteomyelitis of the ankle joint, which cannot be healed by conservative
treatment, to restore walking capability in conus-cauda equina lesions.
