Lower limb amputations at a Nigerian private tertiary hospital.

BACKGROUND Lower Limb amputation remains one of the commonest surgical procedures. The incidence is on the rise in Nigeria due mainly to increasing motorcycle accidents and increased prevalence of uncontrolled diabetes complicated by neuropathy, vasculopathy and diabetic foot gangrene. OBJECTIVE To determine the pattern and outcome of lower limb amputations in a private tertiary setting. METHODS This was a 10-year retrospective review of lower limb amputations done at Havana Specialist Hospital (HSH), a multi-specialist private hospital in Lagos, Nigeria. Utilizing theatre and ward records, case notes of patients that had lower limb amputations in the hospital between 1997 and 2006 were studied. RESULTS A total of 68 lower limb amputations performed on 64 patients were studied. All were closed amputations. Ages 2 to 76 years were affected with a mean of 36.0 +/- 16.2 years and peak age in the 21-30 year group. There were 44 (68.8%) males and 20 (31.2%) females, showing a male to female ratio of 2:2.1. Trauma was the most common indication accounting for 42 (61.8%). Motorcycle related accidents were implicated in 26 (61.9%) of the trauma related cases followed by 8 (19.0%) pedestrians involved in road traffic accidents, while 30 (71.4%) of the patients with trauma had visited traditional bone setters before presenting at the hospital. Below knee amputation was done in 51 (75.0%) of cases and stump wound infection was found in 18 (26.5%). Three (4.7%) patients died. Fifty-five (77.9%) amputation stumps healed by primary intention. Postoperative hospital stay ranged from 21 to 72 days. CONCLUSION Most lower limb amputations were done on young adult males and were mostly due to trauma, predominantly from motorcycle accidents. Majority of the stumps healed by primary intention. Mortality was highest in diabetic related amputations.