References

The World Health Organization. Diabetes: key facts. 2020. https://www.who.int/news-room/fact-sheets/detail/diabetes (accessed 14 February 2021)

Carmona GA, Hoffmeyer P, Herrmann FR Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease. Diabetes Metab. 2005; 31:(5)449-454 https://doi.org/10.1016/S1262-3636(07)70215-X

Varma P, Stineman MG, Dillingham TR. Epidemiology of limb loss. Phys Med Rehabil Clin N Am. 2014; 25:(1)1-8 https://doi.org/10.1016/j.pmr.2013.09.001

Ziegler-Graham K, MacKenzie EJ, Ephraim PL Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008; 89:(3)422-429 https://doi.org/10.1016/j.apmr.2007.11.005

Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 13 1. 1998; 139:1-119

Stern JR, Wong CK, Yerovinkina M A meta-analysis of longterm mortality and associated risk factors following lower extremity amputation. Ann Vasc Surg. 2017; 42:322-327 https://doi.org/10.1016/j.avsg.2016.12.015

Unwin N Epidemiology of lower extremity amputation in centres in Europe, North America and East Asia. Br J Surg. 2002; 87:(3)328-337 https://doi.org/10.1046/j.1365-2168.2000.01344.x

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Fard B, Dijkstra PU, Voesten HG, Geertzen JH Mortality, reamputation and preoperative comorbidities in patients undergoing dysvascular lower limb amputation. Ann Vasc Surg. 2020; 64:228-238 https://doi.org/10.1016/j.avsg.2019.09.010

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Orr TG. The guillotine amputation. Ann Surg. 1919; 69:(5)543-547 https://doi.org/10.1097/00000658191905000-00010

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A guillotine amputation at the ankle level—how to quickly remove a septic foot: a case report

02 September 2021
9 min read
Volume 5 · Issue 4

Abstract

As of 2014, diabetes is estimated to affect 422 million people globally. It is well recognised that lower extremity amputations secondary to diabetes have a high mortality rate perioperatively. The purpose of this article is to provide a simple, step-by-step guide to surgeons who need to perform a transtibial amputation. The case report of a 62-year-old female patient with poorly controlled diabetes who developed necrotising fasciitis of the lower extremity and systemic sepsis is used to illustrate the procedure. Knowing how to complete this operation is essential due to its effectiveness in quickly eliminating a source of pedal sepsis.

Diabetes is estimated to have affected 422 million people globally in 2014,1 with a 10-times greater likelihood of an amputation during the lifetime of the individual with diabetes compared with nondiabetic patients.2,3 In 2005, it was believed that there were over 1.6 million amputees living in the US4 and that 185,000 amputations were performed annually.5 It is estimated that, internationally, 25–90% of all amputations are as a consequence of diabetes, peripheral arterial disease or both.6,7 As of 2018, within the US, the Centers for Disease Control reported that 34.2 million people had diabetes and that, annually, there are 130,000 amputations due to the presence of diabetes.8

It is well recognised that lower extremity amputations secondary to diabetes have a high mortality rate perioperatively.6 Although lower extremity amputation is often felt to be less risky than an open infra-inguinal revascularisation procedure, it has been shown that the 30-day mortality risk is much greater with a lower extremity amputation.4 In one study, the mortality rate of a patient with diabetes having undergone a lower extremity amputation was respectively 47.9, 61.3 and 70.6% at the one-, two- and three-year follow-ups.6 Patients with diabetes of ages 75–84 or >85 years who had a lower extremity amputation had 3–4 times higher odds of mortality within the first 12 months.9

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