Lower Extremity Amputation for Ischemia

2018 ◽  
Author(s):  
William C. Pevec
Keyword(s):  
Lower Extremity ◽  
Chronically Ill ◽  
Major Amputation ◽  
Postoperative Management ◽  
Functional Mobility ◽  
Knee Amputation ◽  
Below The Knee ◽  
Psychological Harm ◽  
Independent Ambulation ◽  
Chronic Arterial Occlusive Disease

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed.   Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation This review contains 10 figures, 1 table and 22 references

Lower Extremity Amputation for Ischemia

2018 ◽  
Author(s):  
William C. Pevec
Keyword(s):  
Lower Extremity ◽  
Chronically Ill ◽  
Major Amputation ◽  
Postoperative Management ◽  
Functional Mobility ◽  
Knee Amputation ◽  
Below The Knee ◽  
Psychological Harm ◽  
Independent Ambulation ◽  
Chronic Arterial Occlusive Disease

Major amputations (proximal to the ankle) of the lower extremity are the manifestations of end-stage, nonreconstructable chronic arterial occlusive disease. A well-performed amputation provides the patient with the best prognosis for return to functional mobility. However, an amputation that fails to heal primarily may cause substantial physical and psychological harm to an already chronically ill patient. Minor amputations (at the toe or forefoot level) are not technically complex, but poor patient selection or technical imperfection can result in major amputation and loss of independent ambulation. In this chapter, selection of the level of amputation is reviewed; the methods to perform digital, forefoot, transtibial, and transfemoral amputations are presented; and postoperative management and potential complications are discussed.   Key Words: above-the-knee amputation, below-the-knee amputation, Guillotine amputation, ray amputation, transmetatarsal amputation, transphalangeal amputation This review contains 10 figures, 1 table and 22 references

The Role of Revascularization in Transmetatarsal Amputations

2001 ◽  
Vol 91 (10) ◽  
pp. 533-535 ◽  
Author(s):  
Javier La Fontaine ◽  
Alex Reyzelman ◽  
Gary Rothenberg ◽  
Khalid Husain ◽  
Lawrence B. Harkless
Keyword(s):  
Lower Extremity ◽  
Diabetes Duration ◽  
Amputation Level ◽  
Knee Amputation ◽  
Below The Knee ◽  
Transmetatarsal Amputation ◽  
The Mean ◽  
Lower Extremity Revascularization

Data from 37 patients who underwent a transmetatarsal amputation from January 1993 to April 1996 were reviewed. The mean age and diabetes duration of the subjects were 54.9 (± 13.2) years and 16.6 (± 8.9) years, respectively. The follow-up period averaged 42.1 (± 11.2) months. At the time of follow-up, 29 (78.4%) of the 37 patients still had foot salvage, 8 (21.6%) had progressed to below-the-knee amputation, and 15 (40.5%) had undergone lower-extremity revascularization. Twelve (80%) of the 15 revascularized patients preserved their transmetatarsal amputation level at a follow-up of 36.4 months. The authors concluded that at a maximum of 3 years follow-up after initial amputation, transmetatarsal amputation was a successful amputation level. (J Am Podiatr Med Assoc 91(10): 533-535, 2001)

scholarly journals First Necrotizing Fasciitis Caused by Haemophilus influenza Serotype a

2017 ◽  
Vol 5 (4) ◽  
pp. 232470961773679
Author(s):  
Giang T. Quach ◽  
Jared Frisby ◽  
Kurt Kralovich ◽  
Mustafa Bohra
Keyword(s):  
Lower Extremity ◽  
Necrotizing Fasciitis ◽  
Skin Infection ◽  
Surgical Intervention ◽  
High Morbidity ◽  
Haemophilus Influenza ◽  
Documented Case ◽  
Knee Amputation ◽  
Left Lower Extremity ◽  
Below The Knee

Necrotizing fasciitis (NF) is an infrequently encountered skin infection that has high morbidity and mortality, even with prompt medical and surgical intervention. We describe the case of a 67-year-old male presenting with significant NF in his left lower extremity, despite aggressive surgical intervention, and included multiple surgical debridements, ACell Matrix, split-thickness, and negative wound VAC therapy. Ultimately, this patient required a below the knee amputation. This is the first documented case of Haemophilus influenza type a causing NF.

Diabetic Limb Salvage

2002 ◽  
Vol 92 (8) ◽  
pp. 457-462 ◽  
Author(s):  
Chad DeNamur ◽  
Guy Pupp
Keyword(s):  
At Risk ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Retrospective Review ◽  
Diabetic Patients ◽  
Team Approach ◽  
Salvage Procedure ◽  
Knee Amputation ◽  
Below The Knee ◽  
Limb Salvage Procedure

In this retrospective review, 19 diabetic patients with significant lower-extremity pathology were assessed to determine the success of limb salvage in cases of varying complexity. The patients were either scheduled or at risk for below-the-knee amputation before intervention. After the limb-salvage procedure, patients were followed for 4 months to 9 years. Eighteen patients went on to have successful procedures, avoiding below-the-knee amputation; one patient had an above-the-knee amputation. The results demonstrate the benefits of an aggressive team approach with limb salvage as a goal. (J Am Podiatr Med Assoc 92(8): 457-462, 2002)

Impact of Interdisciplinary System-Wide Limb Salvage Advisory Council on Lower Extremity Major Amputation

2021 ◽  
Author(s):  
Mehdi H. Shishehbor ◽  
Tarek A. Hammad ◽  
Tonia J. Rhone ◽  
Ahmad Younes ◽  
Norman Kumins ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Major Amputation ◽  
Advisory Council

scholarly journals Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

2018 ◽  
Vol 35 (02) ◽  
pp. 117-123 ◽  
Author(s):  
Jocelyn Lu ◽  
Michael DeFazio ◽  
Chrisovalantis Lakhiani ◽  
Michel Abboud ◽  
Morgan Penzler ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Diabetic Foot ◽  
Functional Outcomes ◽  
Free Tissue Transfer ◽  
Major Amputation ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Flap Survival ◽  
Foot Reconstruction

Background Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. Methods Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K.K.E.). In all cases, microsurgical reconstruction was offered as an alternative to major amputation for the management of recalcitrant DFUs. Overall rates of flap survival, limb salvage, and postoperative ambulation were evaluated. The lower extremity functional scale (LEFS) score was used to assess functional outcomes after surgery. Results Overall rates of flap success and lower limb salvage were 93 and 79%, respectively. Flap failure occurred in two patients with delayed microvascular compromise. Seven patients in this series ultimately required below-knee amputation secondary to recalcitrant infection (n = 5), intractable pain (n = 1), and limb ischemia (n = 1). The average interval between FTT and major amputation was 8 months (r, 0.2–15 months). Postoperative ambulation was confirmed in 25 patients (86%) after a mean final follow-up of 25 months (r, 10–48 months). The average LEFS score for all patients was 46 out of 80 points (r, 12–80 points), indicating the ability to ambulate in the community with some limitations. Conclusion FTT for the management of recalcitrant DFUs is associated with high rates of reconstructive success and postoperative ambulation. However, several patients will eventually require major amputation for reasons unrelated to ultimate flap survival. These data should be used to counsel patients regarding the risks, functional implications, and prognosis of microvascular diabetic foot reconstruction.

Salvage of a Below-the-Knee Amputation Level Following a Type-IIIB Open Tibial Fracture

2007 ◽  
Vol 89 (12) ◽  
pp. 2769-2778 ◽  
Author(s):  
Steven J Morgan ◽  
Justin Newman ◽  
Kagan Ozer ◽  
Wade Smith ◽  
Raffi Gurunluoglu
Keyword(s):  
Tibial Fracture ◽  
Open Tibial Fracture ◽  
Amputation Level ◽  
Knee Amputation ◽  
Below The Knee ◽  
Type Iiib
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