Abstract
Major lower extremity amputation remains a common outcome in the setting of acute and chronic limb ischemia. While often viewed as a failure by the vascular surgeon, it should rather be viewed as the opportunity to give the patient a new leg to ambulate on. As such, it should be performed with as much thought and care as bypass surgery itself. Accurate and timely assessment of the ischemia allows the surgeon to achieve the most functional level of amputation while saving as much of the leg as possible. Surgical techniques are outlined below in detail for the below-knee, ERTL, knee disarticulation, and above-knee amputations.
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References
Endara M, Masden D, Goldstein J, Gondek S, Steinberg J, Attinger C. The role of chronic and perioperative glucose management in high-risk surgical closures. Plast Reconstr Surg. 2013;132(4):996–1004.
Naschitz JE, Lenger R. Why traumatic leg amputees are at increased risk for cardiovascular diseases. QJM. 2008;101(4):251–9.
Pell JP, Donnan PT, Fowkes FGR, Ruckley CV. Quality of life following lower limb amputation for peripheral arterial disease. Eur J Vasc Surg. 1993;7(4):448–51.
Brown BJ, Iorio ML, Klement M, Conti Mica MR, El-Amraoui A, O’halloran P, et al. Outcomes after 294 transtibial amputations with the posterior myocutaneous flap. Int J Low Extrem Wounds. 2014;13(1):33–40.
Lin R, Hingorani A, Marks N, Ascher E, Jimenez R, McIntyre T, et al. Effects of anesthesia versus regional nerve block on major leg amputation mortality rate. Vascular. 2013;21(2):83–6. doi:10.1177/1708538113478718. Epub 22 Mar 2013.
Fisher Jr DF, Clagett GP, Fry RE, Humble TH, Fry WJ. One-stage versus two-stage amputation for wet gangrene of the lower extremity: a randomized study. J Vasc Surg. 1988;8(4):428–33.
Burgess EM, Romano RL, Zettl JH, Schrock Jr RD. Amputations of the leg for peripheral vascular insufficiency. J Bone Joint Surg Am. 1971;53(5):874–90.
Tisi PV, Than MM. Type of incision for below knee amputations. Cochrane Database Syst Rev. 2014;8:4.
Brown BJ, Iorio ML, Hill L, Carlisle B, Attinger CE. Below-knee amputation with a vascularized fibular graft and headless compression screw. Plast Reconstr Surg. 2013;131(2):323–7.
Albino FP, Seidel R, Brown BJ, Crone CG, Attinger CE. Through knee amputation: technique modifications and surgical outcomes. Arch Plast Surg. 2014;41(5):562–70. doi:10.5999/aps.2014.41.5.562.
HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2009.
Yin H, Radican L, Kong SX. A study of regional variation in the inpatient cost of lower extremity amputation among patients with diabetes in the United States. J Med Econ. 2013;16(6):820–7. doi:10.3111/13696998.2013.801349. Epub 15 May 2013.
Apelqvist J, Ragnarson-Tennvall G, Persson U, Larsson J. Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation. J Intern Med. 1994;235(5):463–71.
Sanders LJ, Robbins JM, Edmonds ME. History of the team approach to amputation prevention: pioneers and milestones. J Vasc Surg. 2010;52(3 Suppl):3S–16S.
Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg. 2010;52 Suppl 3:17S–22.
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Ter Louw, R.P., Brown, B.J., Attinger, C.E. (2017). Major Amputation of the Lower Extremity for Critical Limb Ischemia. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_53
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DOI: https://doi.org/10.1007/978-3-319-31991-9_53
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