Two-stage amputation in patients with unsalvageable limbs and severe foot infection

H. L. Chan, P. Meschberger, M. Menth, B. Egger

Objective

Critical limb ischemia is a frequent finding in daily clinical practice. If not treated promptly and appropriately it may lead to septic gangrene, septicaemia and death. For those patients without any possibilities of (re-)revascularization, amputation remains the only option to save their life. Primary definitive amputation performed with the presence of an acute progressive foot infection carries a high risk of post interventional wound infections (>50%). To reduce this risk several authors have advocated an amputation with secondary wound closure. However, in such patients we adopted a different strategy and report here our experience with a two-stage amputation procedure. The first stage consists of a guillotine ankle amputation and the second one of a definitive amputation above or below the knee.

Methods

A retrospective study was conducted from January 2006 to November 2013 and all patients with unsalvageable limbs were included. Patients with severe foot infection, based on clinical and biochemical signs, underwent a two-stage amputation, all others a primary definitive amputation.

Results

77 patients with an unsalvageable limb were included in the study. 10 patients with and 67 without severe foot infection underwent a two-stage amputation and a primary definitive amputation, respectively. In the two-stage amputation group, the amputation level was above the knee in 2 and below in 8 patients. Mean time of surgery was 43 and 82 minutes for the first and second intervention, respectively, and mean time between the two interventions was 8.5 days (5 -20). One patient (10%) presented a deep stump infection with an abscess and needed another amputation higher up. In the primary amputation group, the amputation level was above the knee in 31 and below in 36 patients. Mean time of surgery was 90 minutes. 5 patients (7.5%) presented with a deep stump infection and needed another amputation higher up.

Conclusion

Study-patients suffering from severe foot infection and undergoing a two-stage amputation demonstrated a similar incidence of stump infections when compared to those without foot infection undergoing a primary definitive amputation. Thus, we conclude that in our patients without possibility of (re-)revascularization and suffering from severe foot infection a two-stage amputation is the treatment of choice.