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Staged below-knee amputations for septic peripheral lesions due to ischaemia
The British Journal of Surgery
|May 1, 1986
Summary
For below-knee amputations in ischemic limbs, guillotine amputation followed by revision surgery significantly reduces the need for above-knee amputation compared to primary below-knee amputation. This approach improves healing outcomes for septic lesions.
Area of Science:
- Vascular Surgery
- Orthopedic Surgery
- Wound Healing
Background:
- Preserving the knee joint is critical in lower limb amputations due to ischemia.
- Clinical healing predictors are unreliable in ischemic patients with septic lesions.
Purpose of the Study:
- To compare the outcomes of primary below-knee (BK) amputation with delayed revision versus initial guillotine BK amputation for ischemic limbs.
- To evaluate the impact of amputation technique on revision rates and healing in patients with septic lesions.
Main Methods:
- Seventy-three patients with likely healing BK amputations were divided into two groups.
- Group A: Primary BK amputation with delayed skin closure.
- Group B: Initial guillotine BK amputation followed by revision surgery after infection control.
Main Results:
- No significant difference in overall operative mortality between Group A (6.7%) and Group B (11.4%).
- Significantly higher above-knee revision rate in Group A survivors (33.3%) compared to Group B (7.7%) (P < 0.01).
- Palpable pulses did not significantly influence healing outcomes.
Conclusions:
- Guillotine BK amputation with delayed revision is superior to primary BK amputation in reducing above-knee revisions for ischemic limbs with septic lesions.
- This strategy improves the viability of the below-knee amputation site and controls sepsis more effectively.