G Warren1. 1. The Leprosy Mission International, Windmill Road, Brentford, London, U.K..
Abstract
INDICATIONS: Lesions limited to the forefoot when reconstruction of the forefoot is impossible. In situations where due to the unavailability of protheses a forefoot amputation has to be done. CONTRAINDICATIONS: Absolute: Badly scarred or destroyed calcaneum and/or heel pad. Osteomyelitis of lower tibia or calcaneum. Malignancy of the heel area. Relative: Inadequate circulation of the heel area. Uncontrolled diabetes mellitus. SURGICAL TECHNIQUE: Forefoot amputation with arthrodesis between tibia and os calcis. Specially applicable in patients with neuropathy because this simple procedure leaves a stable stump. Prosthetic fitting not mandatory. Negligible shortening of limb. POSTOPERATIVE MANAGEMENT: Bed rest, elevation of limb, and protective splinting for 3 postoperative days. Non weight bearing on crutches for the next 2 weeks, then well fitted contact cast with Böhler iron for walking. Application of prosthesis not before bony consolidation. POSSIBLE COMPLICATIONS: Infections. Treat very intensively. RESULTS: Fifty modified Pirogoff procedures were done over 30 years, mostly for leprosy or malignancy. Long-term follow-up available of 16 patients who suffered from leprosy (see Figure 11).
INDICATIONS: Lesions limited to the forefoot when reconstruction of the forefoot is impossible. In situations where due to the unavailability of protheses a forefoot amputation has to be done. CONTRAINDICATIONS: Absolute: Badly scarred or destroyed calcaneum and/or heel pad. Osteomyelitis of lower tibia or calcaneum. Malignancy of the heel area. Relative: Inadequate circulation of the heel area. Uncontrolled diabetes mellitus. SURGICAL TECHNIQUE: Forefoot amputation with arthrodesis between tibia and os calcis. Specially applicable in patients with neuropathy because this simple procedure leaves a stable stump. Prosthetic fitting not mandatory. Negligible shortening of limb. POSTOPERATIVE MANAGEMENT: Bed rest, elevation of limb, and protective splinting for 3 postoperative days. Non weight bearing on crutches for the next 2 weeks, then well fitted contact cast with Böhler iron for walking. Application of prosthesis not before bony consolidation. POSSIBLE COMPLICATIONS: Infections. Treat very intensively. RESULTS: Fifty modified Pirogoff procedures were done over 30 years, mostly for leprosy or malignancy. Long-term follow-up available of 16 patients who suffered from leprosy (see Figure 11).