Syme amputation: results in patients with severe forefoot ischemia

Modrall, J. Gregory; Baek, S.; Harvey, Francis; Siegal, Alexandra; Rosental, John J.; Yellin, Albert E.

doi:10.1016/0967-2109(96)83790-2

Cited by 13 publications

(4 citation statements)

References 9 publications

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“…Two patients who evolved unfavorably despite having a permeable PTA failed due to infectious compromise of residual tibial. Clinically there were no signs of infection in the ankle, but as a protocol procedure, the remaining bone samples were taken diabetic dysvascular patients who underwent a preoperative revascularization procedure (5,24) . In our series, initially, ten patients had their PTA occluded, eight were revascularized, three the PTA became permeable, and five patients achieved a satisfactory heel pad revascularization due to collateral vessels.…”

Section: Discussionmentioning

confidence: 99%

Diabetic patients with inadequate flow of the posterior tibial artery and in dialysis are not good candidates for Syme amputation

Cafruni¹,

Parise

Araujo

et al. 2022

J Foot Ankle

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Objective: There is a renewed interest in Syme amputation (SA) as it is considered a “lower limb salvage” procedure. The aim of this study was to describe the characteristics and evolution of diabetic patients who underwent SA to search for factors that would affect the outcome by comparing a group of patients who had a successful amputation against those who required a major amputation. Methods: Seventeen diabetic patients submitted to non-traumatic SA between 2008 and 2016 were analyzed retrospectively. Results: Eight patients required a higher level of amputation. In this group, six patients continued with the posterior tibial artery (PTA) occluded despite the revascularization, and seven were on dialysis. When assessing the permeability of PTA and dialysis as predictors of failure, they multiplied the risk by 20 (cOR of 24 and 21, respectively). However, after adjusting for both factors, there was only clinical significance. Conclusion: SA in diabetic patients may be an alternative in those with a preserved heel pad tissue vascularization and permeable posterior tibial artery at the time of surgery. Patients on dialysis are likely to fail with this level of amputation. Level of Evidence IV; Therapeutic Studies; Retrospective Cohort Study.

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Section: Discussionmentioning

confidence: 99%

Diabetic patients with inadequate flow of the posterior tibial artery and in dialysis are not good candidates for Syme amputation

Cafruni¹,

Parise

Araujo

et al. 2022

J Foot Ankle

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“…If, however, any one of the three arteries at the ankle is patent, and the anterior tibial artery was patent in 86% of the patients treated successfully by Syme's amputation, healing is satisfactory. 7 It is therefore probable that this alternative method of ankle disarticulation could be successful in many patients selected for transtibial amputation when Syme's procedure is contraindicated due to heel pathology. Analysis of the gait of patients with partial foot amputations and ankle disarticulation by the conventional methods, has shown it to be superior to that after a partial foot amputation.…”

Section: Discussionmentioning

confidence: 99%

Disarticulation at the ankle using an anterior flap

Robinson

1999

The Journal of Bone and Joint Surgery. British volume

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Disarticulation has been carried out in ten ankles in nine patients in whom it was not possible to use a heel flap. Four patients were able to walk with a prosthesis which gave satisfactory function. In five who were bedridden, healing was achieved and was of sufficient quality to allow transfers. There was no operative morbidity or mortality.This technique can be used instead of a transtibial amputation if necrosis or ischaemia of the heel is a contraindication to conventional Syme's amputation. J Bone Joint Surg [Br] 1999;81-B:617-20. Received 1 October 1998; Accepted after revision 1 December 1998An anterior skin flap taken from the instep can be used to cover the bone ends in disarticulation of the ankle when ulceration or necrosis of the heel prevents the use of the heel flap for a conventional Syme's amputation. This technique was originally described by Baudens 1 and quoted byMurdoch. 2 It can be carried out under regional anaesthesia.It is well tolerated in the unfit patient and avoids many of the problems of the Syme's procedure. Ground contact is acceptable and there are some advantages for the fitting of a prosthesis. Patients and MethodsExperience in the rehabilitation of a 24-year-old patient in whom disarticulation of the ankle had been carried out using skin from the instep rather than a heel flap after a compound fracture of the calcaneum, led us to the use of this method in patients with necrosis of the heel. Patients selected for this procedure had intact skin on the proximal part of the instep but ulceration, fissuring necrosis or infection involving the heel. There was absence of pain at rest, adequate perfusion, colour and temperature with evidence of flow in one of the three arteries to the ankle on testing with a hand-held Doppler apparatus. In one patient a transcutaneous oxygen measurement of 40 mmHg was found in the skin at the instep. A systolic pressure of 30 mmHg in one or more vessels of the ankle is ideal and a transcutaneous PO 2 of 40 mmHg is necessary.Before operation, sepsis was controlled by local cleansing and antibiotics. Diabetic control was optimised. The patients' nutrition was assessed and protein deficiency corrected when possible. Renal insufficiency and cardiac and pulmonary disease were treated. Subcutaneous heparin or fragmin were used to prevent venous thrombosis and embolism. Prophylactic antibiotics including metronidazole and often cefotaxine were used over the perioperative period. Anaesthetic assessment was carried out by ECG and pulmonary function tests, usually leading to the selection of epidural or spinal anaesthesia. Operative technique. The design of the long anterior flap, as an alternative to the Syme's heel flap, was tested initially on cadavers. A rectangular anterior flap based on the tip of the malleoli provided the best cover.The operation is carried out with the patient supine. A tourniquet is applied above the knee, but not inflated. The skin is prepared with povidone iodine. The skin flaps, based on the prominence of the medial and lateral mall...

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