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KMID : 1144920170130020040
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Journal of Wound Management and Research
2017 Volume.13 No. 2 p.40 ~ p.43
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Modified Lisfranc Amputation to Reduce Hematoma Rate in Diabetic Foot Ulcer
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Leem Soo-Seong
Choi M. Seung-Suk
Chang Jung-Woo
Lee Jang-Hyun
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Abstract
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Background: Diabetic foot ulcers (DFU) may result in limb amputations. Lisfranc level amputations follow the tarsometatarsal joint line, which is indented at the second toe ray due to the shortness of the intermediate cuneiform bone. For this reason a dead space inevitably forms at this site underneath the skin. We describe a modified technique for amputations at Lisfranc level obliterating this dead space, which in turn may result in less hematoma.
Methods: Four patients with DFU were operated using a modified Lisfranc amputation. The amputations were performed along the tarsometatarsal joints except for the second toe ray. After enucleation of the first, third, fourth and fifth metatarsals with the scalpel, the second metatarsal was amputated with an oscillating saw at the level of the distal ends of the medial and lateral cuneiforms, leaving the proximal portion of the metatarsal bone connected to the tarsus, thus obliterating the dead space between the cuneiforms. The skin was closed primarily.
Results: Mean follow-up was 16.2 months. All patients were male and their mean age was 69 years. All stumps healedprimarily without developing a hematoma. One of the patients is able to walk on his salvaged foot without orthotic device. The other patientsare in the status of rehabilitation.
Conclusion: The described modification can efficiently reduce the dead space resulting from classic amputation at the Lisfranc level. It remains to be shown in a larger study, if a reduced hematoma rate also results in a lower overall complication rate.
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KEYWORD
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Lisfranc amputation, Diabetic foot, Midfoot amputation, Diabetic foot ulcer, Modified Lisfranc amputation
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