32-4 Amputation Techniques

Current Status
Not Enrolled
Price
$88.00
Get Started

EDITORIAL

» 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.

Nichol L. Salvo, DPM


© 2022 by Data Trace Publishing Company. All rights reserved. Reproduction or translation of any part of this work beyond that permitted by Section 107 or 108 of the United States Copyright Law without the permission of the copyright owner is unlawful. No portion(s) of the work(s) may be reproduced without written consent from Data Trace Publishing Company. Permission to reproduce copies of articles for non-commercial use may be obtained for a fee of $22 per copy from the Copyright Clearance Center, 222 Rose wood Drive, Danvers, MA 01923, 978-750-8400, www.copyright.com.

The ideas and opinions expressed in Foot and Ankle Quarterly are those of the authors and do not necessarily reflect those of the Editor or the Publisher. Publication of an advertisement or other product mentioned in Foot and Ankle Quarterly should not be construed as an endorsement of the product of the manufacturer’s claims. Readers are encouraged to contact the manufacturer with any questions about the features or limitations of the products mentioned. The Publisher does not assume any responsibility for any injury and/or damage to any persons or property arising out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device or of each drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other healthcare professionals, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient.

Disclosure

Data Trace Publishing Company Continuing Education Mission Statement
Data Trace Publishing Company is committed to providing high-quality print and internet-based enduring continuing education programs, including lectures, feature articles, and condensations and commentaries on current clinical podiatric topics and medical risk management topics which lead to improved delivery of patient care and help reduce the potential for medical errors. These programs are provided to meet the educational needs of the podiatric medical profession and thereby enhance the quality of patient care.

Program Objectives
Foot and Ankle Quarterly (FAQ) is a unique program designed to help today’s podiatric physician manage an ever-increasing flow of information. After completing the Foot and Ankle Quarterly, Volume 32 program, the learner should be better able to: develop and refine a perspective on current treatment recommendations, updates, and advances pertinent to podiatric practice; evaluate the implications of the learned information as it pertains to the diagnosis and treatment of podiatric disorders and societal issues and barriers, and; apply current trends, standards, and best practices into learner’s own practice.

Data Trace Publishing Company Continuing Education Accreditation Statement
Data Trace Publishing Company is approved by the Council on Podiatric Medical Education (CPME) as a provider of continuing education in podiatric medicine. Data Trace Publishing Company has approved this activity for a maximum of 6 continuing education contact hours (CECHs). Physicians should claim only the contact hours commensurate with the extent of their participation in the activity.

Estimated time to complete activity: 6 hours
Date of release: March 1, 2022
Expiration Date: March 15, 2025 (unless further validated and extended by provider). For amended dates of activity expiration, please see FAQ Activity Effective Dates at www.datatrace.com).

Commercial Interests
No commercial interest provided financial support for this continuing education activity.

CECH Note
Participants of Volume 32, Issue 4 will receive a maximum of 6 CECHs for a correctly-completed CME Answer Form. In order to qualify for CECHs, a score of 70% or more must be achieved on the written examination material. Any participant who does not pass the first time may take the exam one additional time (within 90 days of receipt of results). One retake test may be taken for a fee of $15. You will be responsible for notifying your state of the number of contact hours you have received.

Participants are required to complete a course evaluation for use in developing future issues and to meet the unique educational needs of podiatric physicians.

FINANCIAL DISCLOSURE INFORMATION

It is the policy of Data Trace Publishing Company to ensure balance, independence, objectivity, and scientific rigor in all of its educational programs. All faculty, presenters, speakers, authors, and reviewers participating in any programs provided by Data Trace Publishing Company are expected to disclose any relevant financial relationships with CPME-defined commercial interests to the program audience. “Relevant financial relationships” are financial relationships of the individual (including those of the individual’s spouse or partner) in any amount occurring within the past 12 months that create a conflict of interest. A commercial interest is any organization manufacturing, producing, marketing, re-selling, or distributing healthcare goods or services consumed by or used on patients. The CPME mandates that the content of accredited activities be objective and independent of commercial bias. The intent of this policy is that readers may form their own judgements about the presentations, using independent review to resolve all identified conflicts of interest.

In addition to disclosing commercial relationships, faculty are advised of the following policies:

Each continuing education planner and author has submitted a Conflict of Interest Disclosure in order to identify relevant financial relationships and resolve conflicts.

Limitations on Data: Presenter will ensure, to the extent possible, meaningful disclosure of limitations on data (e.g., ongoing research, interim analyses, preliminary data, or unsupported opinion).

Discussion of Unapproved Uses: If unapproved (unlabeled) uses are discussed during the continuing education activity, the presenter will disclose when a product is not approved in the United States (and/or the nation where the activity takes place) for the use under discussion.

Data Trace Publishing Company has identified the option to disclose as follows:

The following authors have disclosed whether they or a member of their immediate family:

  1. Will be receiving an honorarium for this activity
  2. Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they will refer as speaker or author:
    1. Received monetary or other significant research support
    2. Are or had been a paid consultant
    3. Are or had been a full-time or part-time employee
    4. Are or had been a paid or unpaid member of an advisory or similar board
    5. Are or had been a member or on the Board of Trustees
    6. Other
  3. Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they will refer as speaker or author, BUT will not be recommending any of their products over similar competitor products
  4. Within the past 12 months, had a financial or other significant relationship with a commercial organization that markets a product to which they will refer as speaker or author, AND will be recommending one or more of their products over similar competitor products. Recommendation will be based on:
    1. Exclusively on data and/or clinical experience not generated by the manufacturer or derived from manufacturer-sponsored studies
    2. Data and/or clinical experience most of which were not generated by the manufacturer or derived from manufacturer-sponsored studies
    3. Data and/or clinical experience, most of which were generated by the manufacturer or derived from manufacturer-sponsored studies
    4. Exclusively on data and/or clinical experience generated by the manufacturer or derived from manufacturer or derived from manufacturer-sponsored studies
    5. Have no conflicts to disclose

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.)

32-4 Contributors

Guest Editor

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

Contributors

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
  • CONTINUING EDUCATION QUESTIONNAIRE