Crush amputation of foot advice

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dear all,
sorry for the long absence.

here with 40 year old male with train traffinc injury to his right foot.
treatment options please?
suresh

 

Re: crush amputation foot

WOW!
Tx options?
I assume you're being facetious.

Steve

BTW: Where was the photograph taken?

 

Re: crush amputation foot

Suresh

Without knowing which structures are viable or non-viable, and without an x-ray, I would think the kindest thing for this poor person would be a below knee ampuation.

I am not sure wether a Symes amputation is worth considering, but a BKA can more easily and predicably accomodate a prosthesis long term...

Good luck, I'm glad this is not my patient.

LL

 

on table we noticed, great toe was found to be pink and signs of bleeding present.
all the tarsometatarsal joints were disrupted and metatarsal bone was hanging with some soft tissue attachment. all the structures were crushed.
sorry,I don't have the x ray pictures.

gandhi

 

Suresh,

Has the patient been waiting on the operating table since the 19th April 2007 while you have been deciding what to do??

 

Suresh,

Always a problem to decide as you hope for the best. There may be a blood supply to the hallux and elsewhere in the area but skin grafting would be a long shot. A Symes is a possibility but again, looking at the photos, there will be a problem with skin in on the anterior section of the leg.

We did try a Symes in a very similar accident but it ended with a below knee amputation.

Having said that you could get a fortunate result, there`s a lot to consider depending on the patient; it may be better to go straight for a below knee rather than successive chipping away.

What was the outcome ?

 

Ian, thanks for noticing the date on the pictures.but question I want to know your opinion.
will send the follow-up soon ( trying recent follow up.)
suresh

 

pre- operative plan was to go for BK amputation.
but i decided to preserve the viable bony stump on table.
debrided all the non viable tissues followed by
K wire fixation for all the metatarsal to the tarsal bones were done.
with help of daily saline dressing
11 th POD, he had nice granulation and we proceeded with split skin grafting
final picture was taken after 3 months
now he is walking without foot wear at home.
using special foot wear for out door walking
will send recent follow up

suresh

 

i am having problem in loading my pictures
what can i do now?
suresh

 

I would be very interested to see what he ended up with.
Steve

 

Re: crush amputation foot

:dizzy:

Nah..a bit of salt and crushed garlic should do it, then boil the bloody thing!

:deadhorse:

 

'OUCH!' It doesn't look like it can be saved. I'd look at a BKA.

KIWI AD

 

thanks for admin to increase my storage capacity.
i have attached ,immediate and 11 days after fixation.
3 months follow up pt is doing well
i will sent recent follow up soon.

suresh

 

Testimony indeed to the incredible resilience of biological systems to bounce back in the face of incredible adversity..... oh sorry, I ment to say, testimony to the amazing surgical skills of Suresh.

It will be useful to know if this unfortunate man has retained enough pain free function to warrant this salvage. I look forward to Suresh's further posts.

Fantastic set of pictures.

 

well done suresh for your Fabulous work in preserving the limb

 

Suresh,

Truly amazing surgery.

May I enquire which doner sites were used?

Regards,

 

twirly,
i usually prefer opposite thigh for taking graft.
this case we had taken all around the thigh except posterior aspect

suresh

 

I have come in late on this conversation, but the flap under the foot was going to be the skin graft which was already attatched to the foot with a good blood supply.

These op's still amaze me.

Karen

 

1 year follow up, he is walking comfortable on the even surfaces.
and occasionally having skin damage over the plantar aspect.
any suggession regarding footwear.
suresh

 

What a great thread. I would imagine some type of rockersole would be usefull in deceasing pressures on the distal stump?...Would be interesting to see the long term effects on proximal structures due to the altered gait