Amputations of the Lower Extremity

Background:

• Over 130,000 amputations performed in 1997
• 68% of amputees carry diagnosis of diabetes
• Goals of amputation are to optimize function and minimize morbidity

Reasons to amputate:

• Peripheral vascular disease associate with diabetes
• Infection
• Trauma
• Frostbite
• Burn
• Tumor

Types of lower extremity amputations:

Toe Ray – phalanges with all/part of metatarsal 5^th ray most common, useful multiple ray amputations often narrow foot too severely Midfoot amputation Transmetatarsal Lisfranc – through tarsometatarsal joints Hindfoot amputation – Chopart talus and calcaneus preserved Syme talus and calcaneus removed with preservation of heel fat-pad to cover distal tibia/fibula fat-pad migration poses problem to future weight bearing Transtibial (below-knee amputation, BKA) most commonly performed major limb amputation 90% of amputees will successfully use a prosthesis Transfemoral (above-knee amputation, AKA) approx. 90% of amputees will walk with a prosthesis Knee Disarticulation
	Transmetatarsal amputation on right foot and metatarsophalangeal toe amputation on left.
	Chopart Amputation: Talus and Calcaneus are retained.
	Syme Amputation

Considerations:

• Most distal level possible performed
• Adequate soft-tissue required for closure without tension
• Flap thickness and flap location
• Distal muscle stabilization
• Periosteum preservation (in adults)
• Neuroma prevention by clean transection of major nerves
• Early post-op ambulation with use of rigid dressings (casting)

Complications & Outcomes:

• Wound failure - wound healing is often complicated by diabetes and vascular disease
• More proximal amputations required in 5-10% of cases
• Infection – predisposed by amputation of infected or traumatic limb
• Phantom sensation
• Almost universal among amputees
• Telescoping = sensation that amputated limb is retracting toward stump
• Phantom pain
• Experienced by 60-70% amputees
• Many treatments described, including psychological support.
• Back Pain
• As or more common than phantom limb pain

Transfemoral amputation: Gottschalk techique of anchoring of adductor magnus to lateral femur