Guillotine amputation in the treatment of nonsalvageable lower-extremity infections

Primary definitive amputation performed in the presence of distal-extremity infection carries the risk of wound infection and additional limb loss. We reviewed 75 below-knee amputations performed for nonsalvageable foot infections. Patients were retrospectively divided into two groups: group 1 underwent open ankle guillotine amputation followed by definitive below-knee amputation, and group 2 underwent primary definitive below-knee amputation. In group 1, 97% of patients achieved primary healing after revision, and none required amputation at a higher level. In group 2, 78% of patients achieved primary healing, but 11% required revision of the amputation to the above-knee level. These data supported the following conclusion: guillotine ankle amputation followed by below-knee amputation for the nonsalvageable, infected lower extremity is associated with a significantly lower amputation failure rate than primary definitive amputation.