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