AMPUTATION PRINCIPLES OF LOWER EXTREMITY CHRONIC PERIPHERAL ARTERIAL OCLUSIONS

Abstract

Peripheral arterial occlusion of lower extremities is frequently typically seen in societies, which are well developed and have higher income. Atherosclerotic vascular diseases, thromboangitis obliterans, diabetic angiopaties are the main ones of this group disease and they may always result in amputation. The most important problem of performing amputation in peripheral arterial diseases of lower extremities is determining the level of optimal amputation. The success of the treatment depends on the right determination of the antagonism by the orthopaedic surgeon between the better wound healing of proximal amputation and protecting the functions with distal amputation. Different methods are in use for the most successful amputation. In order to determine the most distal level of amputation. Among these methods transcutaneous partial oxygen tension measured and doppler US methods are the best and the most acurate ones. Besides, the criteria, which were described by Pinzur, are an important guide to determine the level of amputation in chronic peripheral arterial occlusion. The orthopaedic surgeon who is going to do the amputation surgery in chronic arterial occlusion must be well experienced. The success of the rehabilitation depends on the surgeon’s experience in many aspects. Even transtibial amputations, which are done 1/3 proximal of the cruris in chronic peripheral arterial occlusions usually cause problems. Many studies have been done to eliminate these problems. The color of muscle, circulation and presence of contracture must be well evaluated before the surgery by the surgeon in order not to cause any revascularization problem at the residuel extremity. Even if the muscles at the transtibial amputation area may have normal vascularization during the surgery, they may become necrotic in a short time after amputation due to the reflex proximal vasospasm.