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Christopher E Attinger - One of the best experts on this subject based on the ideXlab platform.
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ankle disarticulation an underutilized approach to staged Below Knee Amputation case series and surgical technique
Journal of Foot & Ankle Surgery, 2020Co-Authors: Paul Carroll, Christopher E Attinger, Kevin Ragothaman, Alissa Mayer, Christopher J Kennedy, John S SteinbergAbstract:The staged approach to Below Knee Amputation has proven to be an effective method of achieving functionality after Amputation and reducing risk for postAmputation complications. Transtibial or "guillotine" Amputations are often used as the first-stage Amputation. Disarticulation at the ankle joint is an alternative method that can be used with favorable results and benefits. These include rapid infection decompression while minimizing the blood loss of traditional tibial osteotomy. Here we describe our operative technique, perioperative management, and indications for this surgical procedure.
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ertl Below Knee Amputation using a vascularized fibular strut in a nontrauma elderly population a case series
Annals of Plastic Surgery, 2014Co-Authors: Benjamin J Brown, Matthew L Iorio, Lauren Hill, Mitch Klement, Michael Conti R Mica, Amine Elamraoui, Christopher E AttingerAbstract:BACKGROUND Tibiofibular bone bridging (Ertl) during a Below-Knee Amputation (BKA) is used to create a stable bony platform, granting the patient improved rotary stability, higher end bearing potential, and ultimately, more functional ambulatory ability. However, limited data are available in the literature on actual patient outcomes, despite numerous reports of the technique. The purpose of this study was to report our experience with distal tibiofibular bone bridging using a vascularized fibular bone graft in an elderly nontrauma population. METHODS We performed an institutional review board-approved, retrospective review of BKAs performed by the senior author between 2004 and 2011. Surgical indications, complications, and outcomes were recorded. A subgroup analysis and comparison was performed among patients that had received vascularized bone bridging and those that had not. RESULTS A total of 294 BKAs were performed on 270 nontrauma patients. Of these, 30 (11%) were done on 29 patients with tibiofibular bone bridging. The mean clinical follow-up among the Ertl subgroup was 11 months (range, 1-42 months), and 17 months (range, 23 days-78 months) in the non-Ertl subgroup. The ambulation rate was 100% (29/29) in the Ertl group, and 78% (161/207) in the control group (P = 0.004). The overall rate of operative revision due to any etiology among groups did not differ significantly (P = 0.255). CONCLUSIONS Tibiofibular bone bridging with vascularized fibula leads to a significantly higher rate of ambulation without a significantly higher rate of complications in a nontrauma population. Although this technique has been widely described in trauma patients, clinical data are lacking for the nontrauma population. This is the largest reported series of Ertl Amputations in nontraumatic population to date and our results demonstrate a significant benefit of the Ertl technique in this population. LEVEL OF EVIDENCE Level IV.
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Below Knee Amputation with a vascularized fibular graft and headless compression screw
Plastic and Reconstructive Surgery, 2013Co-Authors: Benjamin J Brown, Matthew L Iorio, Lauren Hill, Brian Carlisle, Christopher E AttingerAbstract:Distal tibiofibular bridging (Ertl modification) in a Below-Knee Amputation can provide an improved transmission of torque from the distal femur to the prosthesis. Without this bridge, the distal tibia and fibula are left freely rotating and translating in the soft-tissue envelope. The distal fibular segment creates a bone bridge that allows for increased distal weight bearing and more versatile prosthetic design. The purpose of this article is to describe the authors' technique for performing the Ertl modification to the Below-Knee Amputation using a segment of vascularized fibula and a headless compression screw.
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the Below Knee Amputation to amputate or palliate
Advances in wound care, 2013Co-Authors: Benjamin J Brown, Christopher E AttingerAbstract:Significance: A Below-Knee Amputation (BKA) can be the most functional option for select patients with a diseased lower extremity and may offer a better quality of life than limb salvage in some patients. Recent Advances: Because of advances in prosthetic technology, some patients may have a better quality of life with a BKA than a salvaged lower extremity. Those who cannot wear a prosthesis will do better with a poorly functioning leg. Understanding which patients will not benefit from an Amputation helps ensure that a maximum of patients will continue ambulating. Critical Issues: We lack a thorough understanding of which patients will be more functional with a BKA than a salvaged extremity. Some will do better with a prosthesis, whereas others will do better with a poorly functioning peg leg. This is because so many amputees never wear their prosthesis. Future Directions: A better understanding of patient selection and optimal operative technique would allow us to better council patients as to how to op...
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salvage of traumatic Below Knee Amputation stumps utilizing the filet of foot free flap critical evaluation of six cases
Plastic and Reconstructive Surgery, 1995Co-Authors: Armen K Kasabian, Paul M Glat, Yosef Eidelman, Stephen R Colen, Michael T Longaker, Christopher E Attinger, W C ShawAbstract:Over a 12-year period between 1979 and 1991, 27 patients were operated on at the New York University Medical Center for salvage of Below-Knee Amputation stumps utilizing free flaps. Six different donor sites were used. In 6 patients, the amputated foot was the donor site for a free flap to cover the tibial stump. There were 3 males and 3 females in this group. Five of the patients underwent immediate filet of foot reconstructions, while 1 patient had a reconstruction performed 69 days after injury, electively, when it was determined that Below-Knee Amputation was the best option. All foot flaps survived and ultimately provided the major soft-tissue coverage for the Below-Knee Amputation stump. The length of hospitalization ranged from 24 to 118 days. The time required from foot filet procedure to ambulation was 2, 4, 6, 7, 9, and 12 months in the 6 patients. Five of the 6 patients have resumed work or school after their injury. Foot flaps were based on the posterior tibial artery, anterior tibial artery, or both vessels. Nerve anastomosis of the posterior tibial nerve was performed in 5 patients. In 1 patient it was possible to maintain the continuity of the posterior tibial nerve. Five of the 6 patients were tested over a year after the flap, and all have good cold, pressure, and vibration sensation. Two of the 5 patients have heat sensation, and all 5 patients have at least protective pressure sensation. All the patients ambulate well with a Below-Knee prosthesis.
Ian L. Valerio - One of the best experts on this subject based on the ideXlab platform.
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Targeted Muscle Reinnervation Technique in Below-Knee Amputation.
Plastic and reconstructive surgery, 2019Co-Authors: J. Byers Bowen, Daniel Ruter, Corinne Wee, Julie M. West, Ian L. ValerioAbstract:Approximately 25 percent of major limb amputees will develop chronic localized symptomatic neuromas and phantom limb pain in the residual limb. A method to treat and possibly prevent these pain symptoms is targeted reinnervation. Previous studies prove that targeted reinnervation successfully treats and, in some cases, resolves peripheral neuropathy and phantom limb pain in patients who have undergone previous Amputation (i.e., secondary targeted reinnervation). This article seeks to share the authors' clinical indications and surgical technique for targeted muscle reinnervation in Below-Knee Amputation, a surgical description currently absent from our literature. Targeted reinnervation for the Below-Knee amputee has been performed on 22 patients at the authors' institution. Each patient has been followed on an outpatient basis for 1 year to evaluate symptoms of neuroma or phantom limb pain, patient satisfaction, and functionality. All subjects have denied neuroma pain following Amputation. The majority of subjects reported phantom pain at 1 month. However, at 3 months, all patients reported resolution of this pain. Dumanian et al. first noted the improvement of symptomatic neuroma and phantom limb pain in patients undergoing targeted reinnervation to provide intuitive control of upper limb prostheses. These findings have been substantiated by multiple previous studies at various Amputation levels. This study extends the success of targeted muscle reinnervation to Below-Knee Amputations and provides a description for this technique.
Reuben A. Bueno - One of the best experts on this subject based on the ideXlab platform.
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Surgical Technique for Below-Knee Amputation with Concurrent Targeted Muscle Reinnervation.
Plastic and reconstructive surgery. Global open, 2020Co-Authors: Timothy H.f. Daugherty, Rajiv P. Parikh, Brian A. Mailey, John M. Felder, Reuben A. BuenoAbstract:Targeted muscle reinnervation (TMR) is beneficial for decreasing pain following Below-Knee Amputation (BKA). While most current literature describes the principles behind primary TMR, they provide few principles key to the Amputation, as the BKA is usually performed by another surgeon. When the BKA and TMR are performed by the same surgeon, it can be performed through the same surgical access as needed for both procedures. The purpose of this article is to describe our anatomically based BKA technique in the setting of planned primary TMR as performed by 3, single, peripheral nerve plastic surgeons at 2 institutions. Advantages of the single-surgeon technique include efficiency in dissection, preservation of donor nerve length, limited proximal dissection, early identification of recipient motor nerves for coaptation, ability to stimulate these while still under tourniquet, and decreased tourniquet and operative time. This technique is quick, reliable, and reproducible to help promote widespread adoption of TMR at the time of BKA.
Stefano Bruschi - One of the best experts on this subject based on the ideXlab platform.
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treatment of chronic heel osteomyelitis in vasculopathic patients can the combined use of integra skin graft and negative pressure wound therapy be considered a valid therapeutic approach after partial tangential calcanectomy
International Wound Journal, 2012Co-Authors: Marco Fraccalvieri, Giuseppe Pristera, Enrico Zingarelli, Erind Ruka, Stefano BruschiAbstract:Osteomyelitis of the calcaneus is a difficult problem to manage. Patients affected by osteomyelitis of the calcaneus often have a Below-the-Knee Amputation because of their comorbidity. In this article, we present seven cases of heel ulcerations with chronic osteomyelitis treated with Integra® Dermal Regeneration Template, skin graft and negative pressure wound therapy after partial tangential calcanectomy, discussing the surgical and functional results. In this casuistic of patients, all wounds healed after skin grating of the neodermis generated by Integra®, with no patient requiring a Below-Knee Amputation.
Bauer E Sumpio - One of the best experts on this subject based on the ideXlab platform.
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use of negative pressure wound therapy in healing Below Knee Amputation in patients with chronic venous insufficiency and or charcot disease
Angiology, 2013Co-Authors: On J Sumpio, Alfredo D Cordova, David Mahler, Bauer E SumpioAbstract:Below-the-Knee Amputations in patients who have swollen lower extremities due to chronic venous insufficiency or Charcot disease are particularly vexing clinical problems. The purpose of this paper is to illustrate the role of Negative Pressure Wound Therapy (NPWT) in difficult Below Knee Amputation (BKA) stump closure.