[Modified Pirogoff's amputation]

Principles of Defect Reconstruction After Wide Resection of Primary Malignant Bone Tumors of the Calcaneus: A Contemporary Review

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Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?: A Secondary Analysis of the OUTLET Study

BACKGROUND

The purpose of this study was to compare 18-month clinical and patient-reported outcomes between patients with severe lower-limb injuries treated with a transtibial amputation or a hind- or midfoot amputation. Despite the theoretical benefits of hind- and midfoot-level amputation, we hypothesized that patients with transtibial amputations would report better function and have fewer complications.

METHODS

The study included patients 18 to 60 years of age who were treated with a transtibial amputation (n = 77) or a distal amputation (n = 17) and who were enrolled in the prospective, multicenter Outcomes Following Severe Distal Tibial, Ankle, and/or Foot Trauma (OUTLET) study. The primary outcome was the difference in Short Musculoskeletal Function Assessment (SMFA) scores, and secondary outcomes included pain, complications, amputation revision, and amputation healing.

RESULTS

There were no significant differences between patients with distal versus transtibial amputation in any of the domains of the SMFA: dysfunction index [distal versus transtibial], 31.2 versus 22.3 (p = 0.13); daily activities, 37.3 versus 26.0 (p = 0.17); emotional status, 41.4 versus 29.3 (p = 0.07); mobility, 36.5 versus 27.8 (p = 0.20); and bother index, 34.4 versus 23.6 (p = 0.14). Rates of complications requiring revision were higher for distal amputations but not significantly so (23.5% versus 13.3%; p = 0.28). One distal and no transtibial amputees required revision to a higher level (p = 0.18). A higher proportion of patients with distal compared with transtibial amputation required local surgical revision (17.7% versus 13.3%; p = 0.69). There was no significant difference between the distal and transtibial groups in scores on the Brief Pain Index at 18 months post-injury.

CONCLUSIONS

Surgical complication rates did not differ significantly between patients who underwent transtibial versus hind- or midfoot amputation for severe lower-extremity injury. The average SMFA scores were higher (worse), although not significantly different, for patients undergoing distal compared with transtibial amputation, and more patients with distal amputation had a complication requiring surgical revision. Of note, more patients with distal amputation required closure with an atypical flap, which likely contributed to less favorable outcomes.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Pirogoff amputation is a viable option to maintain ambulation in chronic limb-threatening ischemia with extensive midfoot tissue loss: a report of two cases

Eliminating necrotic and infected tissues is crucial for limb salvage in patients with chronic limb-threatening ischemia (CLTI). However, extensive lesions that involve the midfoot frequently result in transtibial amputation, restricting ambulation and independent life. The Modified Pirogoff amputation, which includes a 90° rotation of the calcaneus and fixation with the tibia, has good functional outcomes in trauma cases. Here, we report two patients with CLTI successfully managed by a combination of revascularization and modified Pirogoff amputation, resulting in preserved ambulation without a prosthesis. Modified Pirogoff amputation may be a good alternative in revascularized CLTI with extensive tissue loss of the midfoot.

Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series

INTRODUCTION

Diabetic-related foot condition is one of the most debilitating complications with a higher rate of failure in limb correction, reconstruction, or salvage surgery. Amputation is the final option after other surgical treatments have failed. Major amputation increases energy consumption, resulting in high dependency, decreased mobility, and poor prognosis. Consequently, minor amputation is preferred to resolve these problems but elevated wound complications leading to inadequate prosthesis fit, became a detriment to minor amputation. Strict selection of patients is crucial to ensure success and good functional outcomes as demonstrated in this retrospective study of this case series. Methods: This case series included six patients who underwent Pirogoff amputation with the modification described by Nather and reported the procedure's outcome. The inclusion criteria for subjects were the presence of palpable posterior tibial artery (PTA) or at least biphasic Doppler signal and ankle-brachial systolic index (ABSI) more than 0.70. Other demographic data as well as hematological, inflammatory, and biochemical parameters that may affect wound healing such as Hb, HbA1c, ESR, CRP, WBC, and albumin were recorded as well. The rate and time for wound healing and bone union, presence of complications, and final ambulatory status of patients were determined as the outcome of this study.

RESULTS

All of the patients had diabetic foot infections involving only the forefoot region with the presence of either palpable PTA or biphasic Doppler signal. Although the majority of the cases had deranged blood parameters, soft tissue and bone healing were achieved at variable times. Four had good outcomes as they were able to ambulate. One case was complicated with chronic wound dehiscence and another one had Pirogoff stump infection and required transtibial amputation.

CONCLUSION

With strict selection criteria, Pirogoff amputation may provide a good functional outcome with a lesser degree of complications compared to major amputation.

Mid- and Hindfoot Amputations in Diabetic Patients

Several surgical options exist to avoid or at least to delay a below-the-knee amputation (BKA). These are the so-called mid- or hindfoot amputations. They are a valuable treatment option in order to maintain the ability to ambulate without major auxiliary means (eg, a prosthesis). Hence, these amputations allow the patients to maintain certain autonomy. The acceptance of these amputations is significantly higher than a BKA, as the body image is less disturbed. The complication rate in hindfoot amputations in diabetic patients is high due to the comorbidities, in particular peripheral arterial disease and polyneuropathy.

Modifications of the pirogoff amputation technique in adults: A retrospective analysis of 123 cases

BACKGROUND

The Pirogoff amputation (1854) was initially developed to provide full-weight-bearing stumps and therefore allow a short ambulation without prosthesis. Modifications of the original technique including Boyd (1939) and the "Modified Pirogoff" were developed, which further reduced complications and improved the outcome. However, the current evidence regarding the techniques is scarce. The functional outcome, survivorship and complication rates are unknown. It was the purpose of this study to expand the knowledge with a retrospective case series and ultimately summarize and analyze the data with a systematic review.

METHODS

A retrospective study of the Boyd procedures from our institution between 1999 and 2018 was performed. Outcome was determined based on the PLUS-M Score (Prosthetic Limb Users Survey of Mobility). Survivorship (absence of more proximal amputation), postoperative leg-length discrepancy, time to early fusion and time to mobilization were also evaluated. Finally, in the second part of the study, the results were integrated in a systematic review, which followed the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of all the studies were then assessed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC).

RESULTS

A total of 123 procedures including 115 patients, with an average follow-up of 45 months (range, 10-300 months) could be included. A very good or good function could be achieved in 85 (69%) patients. The mean survivorship was 82.1% (range 46%-100%). In four studies, including our series, all patients remained with a functional stump at the latest follow-up. The calculated average leg-length discrepancy was 2.5 cm.

CONCLUSION

The "Modified Pirogoff" and Boyd amputation techniques can achieve favourable long-term functional outcome in cases of irreparable foot conditions such as osteomyelitis or trauma. Patency of the posterior tibial artery is an indispensable condition to elect for these surgical techniques. Presence of neuropathy does not preclude this amputation level. With proper patient selection, a maximal survivorship of the stump with treatable minor complications can be achieved.Level of Evidence: IV.