“…6) The advantages of the distal amputation over the Syme amputation include decreased energy consumption during gait due to reduced lower limb length discrepancy, stability of the amputation area, and lower friction with the prosthesis. 7) In the current case, the discrepancy in residual leg length was 2 cm, which was similar to the discrepancy reported in a previous study. 2) Long-distance walking without a prosthesis is not recommended in patients after a partial foot amputation because shock absorption at the heel does not occur during the initial contact, there is no plantar flexion control of the ankle joint, and skin damage is highly probable.…”
“…6) The advantages of the distal amputation over the Syme amputation include decreased energy consumption during gait due to reduced lower limb length discrepancy, stability of the amputation area, and lower friction with the prosthesis. 7) In the current case, the discrepancy in residual leg length was 2 cm, which was similar to the discrepancy reported in a previous study. 2) Long-distance walking without a prosthesis is not recommended in patients after a partial foot amputation because shock absorption at the heel does not occur during the initial contact, there is no plantar flexion control of the ankle joint, and skin damage is highly probable.…”
“…4 The gradual compression at the arthrodesis site maintains additionally stability, even under weight-bearing. 7 Because only a few studies (most with small sample sizes) 3,10,13,16,18,21,22 or case reports 2,12 have described the Pirogoff disarticulation and because all of these studies used different internal or external fixation techniques, including K-wires, cannulated screws, and mono-or bilateral fixators, comparing results is difficult. One important distinction from the Ilizarov technique is the need for a certain period of immobilization without weight-bearing.…”
“…About these criticisms Pirogov wrote “… Although Stromeyer doubts the success of my foot osteotomy plastic surgery, Fergusson makes me an apostate and Syme rejects it as an anti-surgical procedure, so it deserves but special consideration on the part of the war surgeons… ” 20 However, in Pirogov’s support, Theodor Billroth confirmed that he had applied Pirogov’s method to the satisfaction of his patients: “… (They) go admirably on their stumps… ” 33 Pirogov’s method is still used today although modifications have been made to improve outcome and reduce risks of complications (Figure 5). 34–36 Figure 5.Drawings showing the stages in Pirogov’s foot amputation. Figure 1 in the drawing shows the cut surfaces from the side; Figure 2, the surface after disarticulation of the foot; Figures 3 and 4, views of the stump; and Figure 5, the stump as viewed from the front.…”
Section: Surgical Developments Between the Warsmentioning
Nikolay Pirogov qualified as a physician from Moscow University in 1828 and then studied surgery and anatomy at University of Dorpat. He developed new surgical techniques, including the eponymous osteoplastic foot amputation. His application of scientifically based techniques extended surgery from a craft to a science. During the Crimean War he initiated the deployment of women as nurses and used triage for dealing with mass casualties. His textbook on field surgery became the standard reference on the subject and his principles remained virtually unchanged until the Second World War. Pirogov died on 5 December 1881 at his estate in Vishnya.
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