Problem of Revision of Major Lower Extremity Amputation

Abstract

Should one consider a primary above-the-knee (AK) amputation ignoring the benefits of rehabilitation of a below-the-knee (BK) amputation if there is a chance the BK amputation may fail? This is a retrospective study of 112 patients (42% women, 58% men) with an average age of fifty-seven years who under went conversion of a BK to AK amputation. A total of 3,731 BK amputations were performed during the same time period; thus 3% of the total required revisions. Of 29 deaths, 17 patients died of myocardial infarction and 7 second ary to cerebrovascular accident. Of the patients who died, 59% had diabetes and 100% had heart disease: 100% of the patients who died with cardiac causes had hypertension, 83% smoked, and 5% had a history of cerebrovascular acci dent. Thirty-six of the 112 (32%) patients had had a vascular reconstructive procedure previously. The mortality rate of 26% (29/112) reported in this series of patients undergoing revision of BK to AK amputation is similar to that in the reported literature for isolated primary AK amputation. The level of amputa tion was based on vascular evaluation and clinical judgment at the time of oper ation. The lack of increased morbidity and mortality should encourage surgeons to persist in doing as many BK amputations as clinically warranted to improve rehabilitation; no increased mortality occurs in the requirement for a second operative procedure.