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Amputations of the Lower Extremity

  • Joseph Park
  • Tammer Elmarsafi
  • John S. SteinbergEmail author
Chapter

Abstract

Non-traumatic amputations of the lower extremities are a consequence of various medical conditions. The two most common etiologies which lead to lower extremity amputations are peripheral arterial disease and infections. For patients with lower extremity pathology of an ischemic etiology, endovascular and reconstruction options are critical to favorable long-term outcomes. When these corrective measures are exhausted, amputations may become essential. Chronic soft tissue and osseous infections as well as acute infections in the unstable septic patient that require operative management increase the risk of lower extremity amputations. The patient populations most prone to develop both peripheral arterial disease and infections are those with advanced age, smokers, immune compromise, diabetes mellitus, and patients with renal disease. When peripheral polyneuropathy is encountered, patients are at the highest risk for lower extremity amputations. A thorough algorithm provides both the clinician and the patient with the opportunity to moderate disease, mitigate risk, and implement a management strategy that incorporates postoperative function and ambulation as the primary objectives.

Keywords

Diabetes Amputation Wound Ulcer Osteomyelitis Ischemia Infection Complications Outcomes Neuropathy Biomechanics Function 

Notes

Authorship Role, Participation, and Acknowledgments

  1. 1.

    Joseph Park: Provided substantial contributions to conception and design; acquisition of data, analysis, and interpretation of findings; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.

     
  2. 2.

    Tammer Elmarsafi: Provided substantial contributions to conception and design; acquisition of data, analysis, and interpretation of findings; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.

     
  3. 3.

    John S. Steinberg: Provided substantial contributions to conception and design; acquisition of data, analysis, and interpretation of findings; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.

     
  4. 4.

    Jocelyn Lu: MS4 Georgetown University School of Medicine – A special thank you for her contribution in clinical photography and video editing.

     

Financial Disclosures

Joseph Park, Tammer Elmarsafi, and John S. Steinberg have no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report.

Supplementary material

Video 3.1

BKA Amputee: Independent Ambulation (MP4 870 kb)

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Joseph Park
    • 1
  • Tammer Elmarsafi
    • 2
  • John S. Steinberg
    • 2
    • 3
    Email author
  1. 1.Division of Podiatric SurgeryMedStar Washington Hospital CenterWashingtonUSA
  2. 2.Department of Plastic SurgeryMedStar Georgetown University HospitalWashingtonUSA
  3. 3.Department of Plastic Surgery, Center for Wound Healing and Hyperbaric MedicineMedStar Georgetown University HospitalWashingtonUSA

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