Ankle Dorsiflexion Arthrodesis to Salvage Chopart’s Amputation With Anterior Skin Insufficiency

Krause, Fabian; Pfander, Gilles; Henning, Julia; Shafighi, Maziar; Weber, Martin

doi:10.1177/1071100713495380

Cited by 14 publications

(21 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A lot of factors are involved in the decision; vascularity, presence of infection and its level, availability of enough tissue for coverage, patient's age, general health, life expectancy, other co-morbidities and the patients' choice and emotional wellbeing. 9 Complex cases involving unsalvageable forefoot make some surgeons choose the safest operation with the highest success rate neglecting the energy expenditure leading to smaller healthy residual stump in patients who can't mobilize. 10 Moreover HRQoL is a critical indicator of overall patient health; and using The RAND 36 questionnaires in this study showed significant difference between the modified Chopart's and BKA group in the physical function, emotional role limitation and social function.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Modified Chopart’s Amputation; Is It an Alternative to Below Knee Amputation?

Elboushi

Sorour

El-Leboudy

2016

Ain Shams Journal of Surgery

View full text Add to dashboard Cite

To evaluate short term results of both modified Chopart's amputation & below knee amputation in the management of unsalvageable forefoot in diabetic patients.Settings and design: Prospective non-randomized study.Patients and methods: This study was conducted at the vascular surgery unit, Zagazig university hospital between December 2011 and December 2014. The patients were divided into two groups. The 1 st group included 19 patients who underwent below knee amputation (BKA). The 2 nd group included 15 patients who underwent modified Chopart's amputation. Two cases in the first group were excluded because they were missed during follow-up period; the remaining 17 cases included 13 cases of infection and 4 cases of ischemia in the first group while there were 12 cases of infection and 3 cases of ischemia in the second group. The Arabic version of the RAND-36 Survey from the RAND Medical Outcomes Study was used at 12 months postoperatively.Results: In the 1 st group who underwent BKA, 2 patients were excluded from the study because they were missed during follow-up, the remaining 17 patients completed the study; they were 10 males and 7 females with a mean age of 51.2 ±10.5 years. The 2nd group included 15 patients who underwent modified Chopart's amputation; they were 9 males and 6 females with a mean age of 47.9 ±11.05 years. The demographic data were not statistically significant between the two groups. The mean follow up of the patients in both groups was for 17.3 ±1.9 months. Six month walking distance and rehabilitation time were significant between the two groups. The RAND 36 questionnaires in this study showed significant difference between the modified Chopart's and BKA group in the physical function, emotional role limitation and social function, but the two groups were comparable in the other items.Conclusion: Modified Chopart's amputation showed better physical function, emotional role limitation and social function according to the RAND 36 questionnaires in the management of unsalvageable forefoot in selected patients but it isn't a replacement for higher amputations like BKA. Future long term follow up studies with larger sample sizes is needed to further evaluate this technique.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Unlike Krause and colleagues we only included patients that had wounds that can only be closed primary while patients considered for free flap coverage were excluded from this study. 9 We used arthrodesis in 2 cases of plantar ulcers complicating equinovarus deformity.…”

Section: Discussionmentioning

confidence: 99%

Modified Chopart’s Amputation; Is It an Alternative to Below Knee Amputation?

Elboushi

Sorour

El-Leboudy

2016

Ain Shams Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…3 Unfortunately, subjects with CA are prone to developing a severe hindfoot equinus over time due to muscular imbalance of the tibia-gastroc-soleus complex caused either by a developing weakness of dorsiflexors or by dorsiflexors that were not restored during surgery. 4 In addition, the decrease in foot length results in a loss of the biomechanical fore foot lever, leading to a complete loss of the ability to push off in late stance. 5 In order to improve standing and walking in these individuals, a prosthetic device is mandatory to restore the lost biomechanical leverage.…”

Section: Introductionmentioning

confidence: 99%

“…The instrumented five-step staircase (height: 16 cm; depth: 27 cm; width: 100 cm) with handrails on each side. The left side(2,4,6) and the right side(1,3,5) are placed on one force plate each.…”

mentioning

confidence: 99%

Biomechanical analysis of stair ascent in persons with Chopart amputation

Kaib

Schäfer

Block

et al. 2020

Prosthetics &Amp; Orthotics International

View full text Add to dashboard Cite

Background: Compared to walking on level ground, ascending stairs requires a large range of motion not only of the hip and knee joint, but also of the ankle joint. The prosthesis often worn by persons with partial foot amputation largely prevents the ankle motion needed during stair ascent. Objectives: Aim of this study was to assess subjects with a Chopart amputation utilizing a clamshell device during stair ascent to identify potential biomechanical deficits. Study design: Cross-sectional study with reference group. Methods: Six subjects with unilateral Chopart amputation and 17 unimpaired subjects underwent three-dimensional motion analysis while ascending stairs in a step-over-step manner. Results: During weight acceptance, the involved side showed increased external hip-flexing and reduced knee-flexing moments and the sound side a higher ankle power than in the control group. The sound side showed higher external knee-flexing, dorsi-flexing, and hip-adducting moments than the controls during weight acceptance. Conclusion: The mechanism observed on the involved side differs from that in controls, but is comparable to the mechanisms used by subjects with transtibial amputation reported in the literature. However, compensatory movements on the sound side take place at the ankle and knee joint, differing from subjects with more proximal amputations. Clinical relevance This study underpins the importance of adequate foot leverage and ankle function in cases of partial foot amputation, particularly in transfer situations such as stair ascent. If ankle range of motion is adequate, prosthetic/orthotic devices combining shank leverage with a hinged spring mechanism at the ankle may be promising.

show abstract

“… 5 In severe cases in which stump coverage with soft tissue has failed, the decision to give up preservation of the heel and perform a higher level leg amputation may be made. 4 , 6 , 7 We report a case of postoperative extensive necrosis of the tissue covering the stump after Chopart’s amputation of an injured foot. It was successfully treated by secondary stump reconstruction with the combined use of an artificial dermis and anterolateral thigh (ALT) flap.…”

mentioning

confidence: 99%

Reconstruction of Chopart’s Amputation Stump Using Artificial Dermis Combined with Free Anterolateral Thigh Flap

Shimizu

Matsumine²,

Takeuchi

2015

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Summary:A 63-year-old man dropped a metal chunk onto his left foot during his work and suffered a crush injury of the left forefoot. He underwent Chopart’s amputation followed by stump coverage with sole skin at the orthopedic department on the same day. He was referred to our department for reconstruction because of poor vascularization and subsequent necrosis of tissue at the stump. After the necrotic tissue was debrided, exposure of the talus bone was noted. An artificial dermis was then applied to the stump wound, followed by local negative pressure wound therapy. After 3 weeks, the generation of a strong dermis-like tissue was observed at the site of artificial dermis grafting. We then performed flow-through free anterolateral thigh flap grafting to reconstruct the stump wound. This procedure involved suturing of the peroneal muscle group and tibialis anterior muscle, which were cut off during Chopart’s amputation, and suturing the soft tissue surrounding the calcaneus firmly to the fascia lata of the anterolateral thigh flap, followed by suturing of the flap to the skin defect of the left foot. There were neither postoperative complications, such as skin ulcer and equinus/varus deformity, nor need for secondary repair of the grafted flap, so the patient was able to smoothly enter a rehabilitation program including gait training. The current reconstruction technique for the tissue defect following Chopart’s amputation, consisting of artificial dermis grafting, negative pressure wound therapy, and flow-through free anterolateral thigh flap grafting, enabled safe and smooth gait rehabilitation with a forefoot prosthesis.

show abstract

Ankle Dorsiflexion Arthrodesis to Salvage Chopart’s Amputation With Anterior Skin Insufficiency

Abstract: Level IV, retrospective case series.

Cited by 14 publications

References 17 publications

Modified Chopart’s Amputation; Is It an Alternative to Below Knee Amputation?

Modified Chopart’s Amputation; Is It an Alternative to Below Knee Amputation?

Biomechanical analysis of stair ascent in persons with Chopart amputation

Reconstruction of Chopart’s Amputation Stump Using Artificial Dermis Combined with Free Anterolateral Thigh Flap

Contact Info

Product

Resources

About