[Stump retention and extension on the lower extremity]

Area of Science:

• Orthopedics
• Vascular Surgery
• Diabetology

Context:

• Lower extremity amputations are a significant health concern in industrialized nations, with over 100,000 performed annually in the U.S.
• The majority of these amputations (over 90%) are necessitated by gangrene stemming from ischemia and/or infection.
• Micro- and macroangiopathic changes associated with diabetes are the primary drivers of leg ischemia leading to amputation.

Purpose:

• To emphasize the critical importance of preserving limb length and creating an end-bearing stump for optimal functional recovery post-amputation.
• To highlight the necessity of an interdisciplinary approach in managing amputation cases, focusing on soft tissue coverage and stump optimization.
• To explore reconstructive options for improving stump-bearing ability when initial outcomes are insufficient.

Summary:

• Despite advancements in medical techniques and health programs, lower extremity amputation rates remain high, particularly in Western industrialized countries.
• Ischemia, predominantly caused by diabetic micro- and macroangiopathy, is the leading cause for over 90% of amputations performed for gangrene.
• Achieving an end-bearing stump of adequate length is paramount for functional success, especially in trauma and tumor cases, favoring orthotic support over prosthetics where possible.

Impact:

• Improved functional outcomes and patient mobility through optimized stump reconstruction and preservation of limb length.
• Enhanced patient care via a collaborative, interdisciplinary strategy addressing soft tissue coverage and stump viability.
• Reduced need for prosthetic interventions by maximizing the potential for end-bearing stumps and orthotic utilization.