» This issue of Foot and Ankle Quarterly focuses on amputation techniques,
This issue of Foot and Ankle Quarterly focuses on amputation techniques, the various indications for amputation and some of the complications and long-term sequela of amputation procedures. Limb salvage is an important component of the podiatry scope, and within the Veterans Health Administration (VHA), is a critical part of the care provided to our Veteran patients.
VHA Directive 1410 Prevention of Amputations in Veterans Everywhere (PAVE) was instituted nation- wide almost three decades ago. The directive commits the VHA to monitor several metrics, including but not limited to the number of diabetics and others at-risk for amputation conditions enrolled in the VHA, the number of new foot ulcers, and the amputation rates and ratios within the VA. Since its inception, with a combination of multidisciplinary efforts, patient-centric care and ensuring that patients who are at increased risk for amputation have access to podiatry services, it not only has reduced the overall amputation rates, but the ratio between minor and major amputations has improved with an increase in more distal amputations, avoiding major amputations and preserving more functioning joints. Given the tremendous impact made within the VA, I was motivated to devote this issue to limb salvage and amputation techniques with all contributions strictly from VA podiatric surgeons.
The audio lectures provided by Dr. Danae Lowell and Dr. Shahzad Ghori broadly cover several different amputations, their respective techniques, indications for amputation, preoperative work-up and biomechanical considerations. The feature article I have written is much the same, incorporating literature and research to support. The remainder of my colleagues introduce important published literature covering several different types of amputations, and in their reviews offer personal commentaries based on their surgical and clinical background. They bring unique perspective to this issue with some carrying military background, and all with a special focus on limb salvage within their practices. I sincerely appreciate the time they each have contributed to this issue.
Regardless of the amputation type and level that is required, a multidisciplinary approach to these complicated, multidimensional patients is critical. They require medical management, vascular optimization and often times infectious disease management. While there are various elements required for a good surgical outcome including patient compliance, co-morbid status and biomechanical effects, a cohesive and involved interdisciplinary team is one of the most critical. The VHA, in its structure and design, allows for easy access of the various, necessary specialties in the shared management of our Veteran patients.
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Article Authors and Lecturers
Shahzad Ghori, DPM (1. Data Trace Publishing Company)
Steven L. Goldman, DPM (n.)
Christopher Japour, DPM, MS (n.)
Luke Kovatch, DPM (n.)
Jennifer L. Kuba, DPM (n.)
Danae L. Lowell, DPM (1. Data Trace Publishing Company)
Sherrill Murad, DPM (n.)
Kittra Owens, DPM (n.)
Sarah Cernica Reichard, DPM (n.)
Kristin Rizzo, DPM (n.)
Nichol L. Salvo, DPM (1. Data Trace Publishing Company)
Kerry Sweet, DPM (n.)
Ashley Willis, DPM (n.)
FAQ Journal Planning Committee
Chrissy Wesolowski (formally Calvert) (n.)
Kimberly Collignon (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)
Nichol L. Salvo, DPM
Podiatry Section Chief, Atlanta VA Health Care System, Atlanta, GA; Diplomate, American Board of Foot and Ankle Surgery; Diplomate, American Board of Podiatric Medicine
Shahzad Ghori, DPM, FACPM, DABPM, AACFAS
Department of Surgery, Podiatry Section, Clinical and Surgical Attending, Podiatric Medicine and Surgery Residency, Departments of Veterans Affairs, Atlanta, GA; Fellow, American College of Podiatric Medicine; Diplomate, American Board of Podiatric Medicine; Associate, American College of Foot and Ankle Surgeons
Steven L. Goldman, DPM, MBA, DABFAS. DABPM, FACPM, FACHE Chief of Podiatry, Martinsburg VA Medical Center, Martinsburg, WV
Christopher Japour, DPM, MS Residency Director, Illiana Healthcare System, Danville, IL; Board of Directors Federal Service Podiatric Medical Association; Board of Directors American Society of Podiatric Surgeons
Luke Kovatch, DPM Director, Podiatry Residency Program, Assistant Chief of Podiatry Section, Jesse Brown VA Medical Center, Chicago, IL; Diplomate, American Board of Foot and Ankle Surgery; Diplomate, American Board of Podiatric Medicine with Certificate of Added Qualification in Amputation Prevention and Wound Care
Jennifer L. Kuba, DPM, DABPM, FACPM, FAPWCA Diplomate, American Board of Podiatric Medicine; Fellow, American College of Podiatric Medicine, Certified Skin and Wound Specialist, Gulf Coast Veterans Healthcare System, Biloxi, MS
Danae L. Lowell, DPM Veterans Affairs Site Director, Mercy Health Medical Center, Cleveland Veterans Affairs Medical Center, Cleveland, OH; Diplomate, American Board of Foot and Ankle Surgery; Diplomate, American Board of Podiatric Medicine; American Association of Colleges of Podiatric Medicine Chair Council of Teaching Hospitals; Veterans Administration Podiatry Field Advisory Committee; On-site Evaluator and Residency Review Committee Member, Council on Podiatric Medical Education; President, Podiatry Residency Resource
Sherrill Murad, DPM Podiatry Section Assistant Chief, Atlanta VA Health Care System, Atlanta, GA; Diplomate, American Board of Podiatric Medicine
Kittra Owens, DPM, FACFAS, FACPM Section Chief, Podiatry/Foot and Ankle Surgery, Foot and Ankle Surgery GME Site Director, VA Southern Nevada Healthcare System, Las Vegas, NY; Diplomate, American Board of Foot and Ankle Surgery. Diplomate, American Board of Podiatric Medicine Fellow, American College of Podiatric Medicine; Fellow, American College of Foot and Ankle Surgeons; Assistant Professor, University of Nevada Las Vegas School of Medicine, Las Vegas, NV; Adjunct Professor, Temple University School of Podiatric Medicine; Philadelphia, PA
Sara Cernica Reichard, DPM Podiatrist, Department of Veteran Affairs, Youngstown, OH; Adjunct Faculty, Kent State University College of Podiatric Medicine, Independence, OH
Kristin K. Rizzo, DPM, FACFAS Director, Podiatric Medicine and Surgery Residency, Atlanta Veterans Affairs Healthcare System, Decatur, GA; Region 5 Representative, Council on Teaching Hospitals; Fellow, American College of Foot and Ankle Surgeons; Fellow, American Professional Wound Care Association; Diplomate, American Board of Foot and Ankle Surgery; Diplomate, American Board of Podiatric Medicine
Kerry Sweet, DPM, FACFAS Section Chief, Podiatric Surgery, VA Puget Sound, Seattle, WA; Board Certified, American Board of Foot and Ankle Surgery; Fellow, American College of Foot and Ankle Surgeons
Ashley Willis, DPM Atlanta VA Medical Center, Atlanta VA Medical Center, Atlanta, GA; Diplomate, American Board of Podiatric Medicine; Board-Certified, American Board of Foot and Ankle Surgery
In This Issue:
FEATURE ARTICLE: Amputation Techniques for Foot Osteomyelitis
Nichol L. Salvo, DPM
CONDENSATIONS and COMMENTARIES
Transmetatarsal and Minor Amputation vs. Major Leg Amputation: 30-Day Re-admissions, Re-amputations, and Complications
Commentary by Sarah Cernica Reichard, DPM
What is the Most Durable Construct for a Forefoot Amputation, Traditional Transmetatarsal Amputation or a Medial Ray-Sparing Procedure?
Commentary by Ashley Willis, DPM
Is Reconstruction Preserving the First Ray or First Two Rays Better than Full Transmetatarsal Amputation in Diabetic Foot?
Commentary by Kristin K. Rizzo, DPM
Chopart Amputation with Tibiotalocalcaneal Arthrodesis and Free Flap Reconstruction for Severe Foot Crush Injury
Commentary by Kittra Owens, DPM
Outcomes of Chopart Amputation in a Tertiary Referral Diabetic Foot Clinic: Data from a Consecutive Series of 83 Hospitalized Patients
Commentary by Sherrill Murad, DPMAnkle Disarticulation: An Underutilized Approach to Staged Below-Knee Amputation-Case Series and Surgical Technique
Commentary by Christopher Japour, DPM, MS
Modifications of the Pirogoff Amputation Technique in Adults: A Retrospective Analysis of 123 Cases
Commentary by Luke Kovatch, DPM
The Modified Pirogoff Amputation in Treating Diabetic Foot Infections: Surgical Technique and Case Series
Commentary by Kerry Sweet, DPM
Syme Amputation: A Systematic Review
Commentary by Steven L. Goldman, DPM
Combination of Open Subtotal Calcanectomy and Stabilization with External Fixation as Limb Salvage Procedure in Hindfoot-Infected Diabetic Foot Ulcers
Commentary by Jennifer L. Kuba, DPM
AUDIO LECTURE 1: Overview, Considerations and Techniques in Lower Extremity Amputations
Shahzad Ghori, DPM
AUDIO LECTURE 2: Osteomyelitis of the Foot and Ankle Leading to Amputation
Danae L. Lowell, DPM