Soft Tissue Balancing After Partial Foot Amputations

Garwood, Caitlin S.; Steinberg, John S.

doi:10.1016/j.cpm.2015.06.005

Cited by 17 publications

(8 citation statements)

References 41 publications

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“…One crucial part of the operative procedure is tendon balancing to prevent postoperative foot deformity which in turn could lead to pressure ulcers. 27 All in all, there are a variety of conservative surgical techniques to prevent limb loss in case of DFO.…”

Section: Osteomyelitis Surgerymentioning

confidence: 99%

Surgical strategies for prevention of amputation of the diabetic foot

Frykberg

Attinger

Smeets

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Prevention of amputation has become a key objective of clinicians providing care to patients with highrisk diabetic foot problems. In this regard, the multidisciplinary diabetic foot team (MDFT) has been embraced as the most effective way to manage patients with foot ulcers, infections, and Charcot feet. Importantly, such specialized teams have also integrated various surgical specialties to enable more expedient management of these often complex conditions. Experienced diabetic foot surgeons over the last three or four decades have contributed much to this discipline, whereby foot-sparing reconstructive procedures or minor amputations have become fundamental strategies for limb preservation teams. Central to limb salvage, of course, is the recognition of underlying vascular insufficiency and the importance of prompt (endo)vascular intervention. Restoration of adequate perfusion is essential to allow the podiatric, orthopaedic, or plastic surgeon to perform indicated functional reconstructive or minor amputation procedures. This evidence-based overview discusses the various indications and surgical principles inherent in modern concepts aimed at preventing amputation in the high-risk diabetic foot.

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Section: Osteomyelitis Surgerymentioning

confidence: 99%

Surgical strategies for prevention of amputation of the diabetic foot

Frykberg

Attinger

Smeets

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…The most common biomechanical complication of a TMA (and other midfoot amputations) is an equinovarus deformity -a resultant imbalance between severed dorsiflexors and intact plantarflexors. Achilles tendon lengthening should therefore be performed at the time of a TMA to reduce risk of equinovarus deformity [15] . Moreover, the shortened foot can be unstable during ambulation and the heel may demonstrate excess movement in the patient's footwear.…”

Section: Transmetatarsal Amputationmentioning

confidence: 99%

Prosthetic and orthotic options for lower extremity amputation and reconstruction

Crowe¹,

Impastato²,

Donaghy³

et al. 2019

PAR

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Lower extremity injury and deformity can result from a number of etiologies. Regardless of the underlying cause, the decision to pursue amputation or reconstruction of a lower limb is challenging for both patients and practitioners. This decision is largely dependent on the patient's premorbid health and function, functional goals and preferences, and characteristics and viability of the affected limb. The role of adaptive devices following surgery should never be underestimated. Advances in prostheses and orthoses have provided patients with a wider range of options to consider when deciding between limb reconstruction and amputation. The primary goals of any adaptive device are to improve function, prevent recurrence or ulceration of the defect, and allow for use of conventional footwear and/or clothing. When a lower extremity amputation is indicated, selection of the correct level is of critical importance in order to optimize healing potential and function. Each distinct level has certain inherent prosthetic and orthotic considerations. Likewise, the application of an adaptive device following reconstruction of the lower extremity also has demonstrable benefits and must be tailored to the specific defect and procedure performed. Knowledge of available prosthetic and orthotic options is of considerable importance for the reconstructive surgeon tasked with limb salvage or resurfacing an amputated extremity. This article reviews considerations of various types of lower extremity amputation and reconstruction, and provides a framework for the role of adaptive devices following surgery.

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“…[4,5] Both amputation types are however controversial because of their postoperative problems, which include difficulties in wound healing, equinus contracture, and the need for re-amputation. [4,6–8]…”

Section: Introductionmentioning

confidence: 99%

“…In order to preserve dorsal flexion after performing a Lisfranc amputation, it is recommended to maintain the base of the first and fifth metatarsals to preserve as much ankle function as possible. [7,9] To prevent an equinus contracture and distal breakdown of the residual limb after a Chopart amputation, an Achilles tenectomy is frequently performed. [7] Other modifications include anchoring the anterior tibialis tendon into the neck of the talus or transferring the posterior tibial tendon to the talus, or utilizing a new technique of balanced tendon transfer modification to the Chopart amputation.…”

Section: Introductionmentioning

confidence: 99%

“…[7,9] To prevent an equinus contracture and distal breakdown of the residual limb after a Chopart amputation, an Achilles tenectomy is frequently performed. [7] Other modifications include anchoring the anterior tibialis tendon into the neck of the talus or transferring the posterior tibial tendon to the talus, or utilizing a new technique of balanced tendon transfer modification to the Chopart amputation. [7,[10][11][12] Despite these modifications, Lisfranc and Chopart amputations are still controversial.…”

Section: Introductionmentioning

confidence: 99%

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Lisfranc and Chopart amputation: A systematic review

2023

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Background: Lisfranc and Chopart amputations are historically controversial procedures. To obtain evidence for the pros and cons we performed a systematic review to analyze wound healing, the need for re-amputation at a higher level, and ambulation after a Lisfranc or Chopart amputation.Methods: A literature search was performed in 4 databases (Cochrane, Embase, Medline, and PsycInfo), using databasespecific search strategies. Reference lists were studied to include relevant studies that were missed in the search. Of the 2881 publications found, 16 studies could be included in this review. Excluded publications concerned editorials, reviews, letters to the editor, no full text available, case reports, not meeting the topic, and written in a language other than English, German, or Dutch.Results: Failed wound healing occurred in 20% after Lisfranc amputation, in 28% after modified Chopart amputation, and 46% after conventional Chopart amputation. After Lisfranc amputation, 85% of patients were able to ambulate without prosthesis for short distances, and after modified Chopart 74%. After a conventional Chopart amputation, 26% (10/38) had unlimited household ambulation. Conclusions:The need for re-amputation because wound healing problems occurred most frequently after conventional Chopart amputation. All 3 types of amputation levels do, however, provide a functional residual limb, with the remaining ability to ambulate without prosthesis for short distances. Lisfranc and modified Chopart amputations should be considered before proceeding to a more proximal level of amputation. Further studies are needed to identify patient characteristics to predict favorable outcomes of Lisfranc and Chopart amputations.

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Soft Tissue Balancing After Partial Foot Amputations

Cited by 17 publications

References 41 publications

Surgical strategies for prevention of amputation of the diabetic foot

Surgical strategies for prevention of amputation of the diabetic foot

Prosthetic and orthotic options for lower extremity amputation and reconstruction

Lisfranc and Chopart amputation: A systematic review

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