ABSTRACT
CONTENTS I. Introduction ...................................................................................................................... 394 II. Initial Assessment and Acute Treatment........................................................................... 395
A. Foot Salvageability .................................................................................................... 395
B. Acute Management — Preoperative .......................................................................... 396
C. Acute Management — Operative .............................................................................. 397 III. Subacute Management ...................................................................................................... 398 IV. Chronic Management........................................................................................................ 401
A. Rehabilitation ............................................................................................................ 401
B. Complications............................................................................................................ 402 V. Specific Amputation Levels ............................................................................................... 404
A. Terminal Syme........................................................................................................... 404
1. Technique............................................................................................................ 404
2. Complications ..................................................................................................... 405
3. Orthotic and Prosthetic Issues............................................................................. 405
B. Great Toe Amputation .............................................................................................. 405
1. Technique............................................................................................................ 406
2. Complications ..................................................................................................... 406
3. Orthotic and Prosthetic Issues............................................................................. 406
C. Lesser Toe Amputation ............................................................................................. 406
1. Technique............................................................................................................ 406
2. Complications ..................................................................................................... 406
3. Orthotic and Prosthetic Issues............................................................................. 407
D. Ray Resections .......................................................................................................... 407
1. Technique............................................................................................................ 408
2. Complications ..................................................................................................... 408
3. Orthotic and Prosthetic Issues............................................................................. 410
E. Transmetatarsal Amputations ................................................................................... 410
1. Technique............................................................................................................ 410
2. Complications ..................................................................................................... 413
3. Orthotic and Prosthetic Issues............................................................................. 413
F. Lisfranc’s Amputation ............................................................................................... 413
G. Chopart’s Amputation............................................................................................... 413
1. Technique............................................................................................................ 414
2. Complications ..................................................................................................... 415
3. Orthotic and Prosthetic Issues............................................................................. 416
H. Syme’s Amputation ................................................................................................... 417
1. Technique............................................................................................................ 417
2. Complications ..................................................................................................... 418
3. Orthotic and Prosthetic Issues............................................................................. 419 VI. Conclusion ........................................................................................................................ 420 References .................................................................................................................................. 421
I. INTRODUCTION
Trauma is the third leading cause of partial and complete amputations of the foot, after only diabetes mellitus and peripheral vascular disease. The mechanisms of injury are diverse and include crush injuries often encountered in the industrial setting, lawn mower and other lacerating trauma, high-energy combination injuries seen with motorcycle crashes, high-velocity gunshot wounds, and thermal injuries from burns or frostbite (Figure 16.1).
