another amputation level
rodgerole at mail.ev1.net
Sat Sep 20 22:12:11 PDT 2003
My prosthetist said that people with a Siems amputation seem to do a lot better than the level I have. Any input? Belinda
Hi Belinda, Not sure if a Symes is possible from what I've read about the two operations. Here is some info on both. Take a look and see what you thinksee what you think. I'd also suggest you do a search for Symes amputation on the web. http://www.momma.com/ is a good place to start. I'm also gonna send you a list of definitions as soon as I can.
Ole rak 01/02
Transtarsal amputations (Chopart, Lisfranc)
Owing to the poor healing and inevitable equinus deformity caused by unopposed contraction of the ankle flexors these amputations are not recommended in either vascular or non-vascular patients.
Syme's operation is the best amputation for patients with extensive non-ischaemic damage to the forefoot. The stump that is produced has the advantage of allowing considerable weight bearing, and thus allows considerable independence in the home without a prosthesis. It may suffice alone in areas where prostheses are not available. The defects of the procedure used to be difficulty in fitting a foot prosthesis because of lack of clearance from the ground, which has now been overcome, and poor cosmesis of the prosthesis in females, due to the thickness at the ankle: this is still a problem. There is a difference between the technique that can be used in children and in adults although the incisions used are similar In children the amputation uses the same heel flap to cover the end of the stump, but the amputation itself can consist of simple disarticulation of the talus, followed by removal of the malleoli, leaving behind most of the joint surface. The anterior incision is !
then deepened through the anterior tendons to allow disarticulation of the talus from the joint. The Achilles tendon is divided posteriorly and the talus and calcaneum are then dissected free from the heel by sharp dissection, staying close to the periosteum to avoid damage to vascular structures. The dissection is particularly difficult over the thin skin at the back of the heel, and there is a danger of ‘buttonholing’ the skin, which can again be avoided by staying close to the periostium. A variant operation described by Boyd is to leave a slice of the calcaneum attached to the heel skin, which can then be attached to the proximal cut bones in a similar manner to the Gritti-Stokes operation. This may lessen the trauma to the tissue but lengthens the stump.
Once the posterior flap has been dissected free the distal foot is removed, leaving the heel flap long at this stage. The exposed distal tibia and fibula are dissected free of adherent tissues staying on the periosteum. A transverse cut is then made approximately 1 cm above the ankle mortice. It is important that this cut is truly transverse, to prevent uneven pressure later when weight bearing. It is also important to leave some element of the malleolar prominence on each side, since this allows stabilization of the prosthesis and prevents rotation. After cutting tendons short and allowing them to retract and ensuring haemostasis the flap is brought over the cut end of the bone and trimmed to a suitable length without tension. The wound is closed by suturing the deep tissues of the heel pad to the deep fascia anteriorly with a suitable atraumatic skin suture.
Syme's amputation requires a relatively good blood supply to the heel pad and most patients that need to lose the foot from vascular disease do not have sufficiently good blood supply to allow this procedure. However, some diabetics with forefoot infection or gangrene may have normal ankle pulses and a Symes amputation can be successful.
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