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Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series

Introduction: Diabetic-related foot condition is one of the most debilitating complications with a higher rate of failure in limb correction, reconstruction, or salvage surgery. Amputation is the final option after other surgical treatments have failed. Major amputation increases energy consumption,...

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Detalles Bibliográficos
Autores principales: Tunku Zainudin, Tunku Naziha, Nachimuthu, Maniventhan, Ibrahim, Mohammad Izani
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613117/
https://www.ncbi.nlm.nih.gov/pubmed/37905257
http://dx.doi.org/10.7759/cureus.46156
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author Tunku Zainudin, Tunku Naziha
Nachimuthu, Maniventhan
Ibrahim, Mohammad Izani
author_facet Tunku Zainudin, Tunku Naziha
Nachimuthu, Maniventhan
Ibrahim, Mohammad Izani
author_sort Tunku Zainudin, Tunku Naziha
collection PubMed
description Introduction: Diabetic-related foot condition is one of the most debilitating complications with a higher rate of failure in limb correction, reconstruction, or salvage surgery. Amputation is the final option after other surgical treatments have failed. Major amputation increases energy consumption, resulting in high dependency, decreased mobility, and poor prognosis. Consequently, minor amputation is preferred to resolve these problems but elevated wound complications leading to inadequate prosthesis fit, became a detriment to minor amputation. Strict selection of patients is crucial to ensure success and good functional outcomes as demonstrated in this retrospective study of this case series. Methods: This case series included six patients who underwent Pirogoff amputation with the modification described by Nather and reported the procedure's outcome. The inclusion criteria for subjects were the presence of palpable posterior tibial artery (PTA) or at least biphasic Doppler signal and ankle-brachial systolic index (ABSI) more than 0.70. Other demographic data as well as hematological, inflammatory, and biochemical parameters that may affect wound healing such as Hb, HbA1c, ESR, CRP, WBC, and albumin were recorded as well. The rate and time for wound healing and bone union, presence of complications, and final ambulatory status of patients were determined as the outcome of this study. Results: All of the patients had diabetic foot infections involving only the forefoot region with the presence of either palpable PTA or biphasic Doppler signal. Although the majority of the cases had deranged blood parameters, soft tissue and bone healing were achieved at variable times. Four had good outcomes as they were able to ambulate. One case was complicated with chronic wound dehiscence and another one had Pirogoff stump infection and required transtibial amputation. Conclusion: With strict selection criteria, Pirogoff amputation may provide a good functional outcome with a lesser degree of complications compared to major amputation.
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spelling pubmed-106131172023-10-30 Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series Tunku Zainudin, Tunku Naziha Nachimuthu, Maniventhan Ibrahim, Mohammad Izani Cureus Orthopedics Introduction: Diabetic-related foot condition is one of the most debilitating complications with a higher rate of failure in limb correction, reconstruction, or salvage surgery. Amputation is the final option after other surgical treatments have failed. Major amputation increases energy consumption, resulting in high dependency, decreased mobility, and poor prognosis. Consequently, minor amputation is preferred to resolve these problems but elevated wound complications leading to inadequate prosthesis fit, became a detriment to minor amputation. Strict selection of patients is crucial to ensure success and good functional outcomes as demonstrated in this retrospective study of this case series. Methods: This case series included six patients who underwent Pirogoff amputation with the modification described by Nather and reported the procedure's outcome. The inclusion criteria for subjects were the presence of palpable posterior tibial artery (PTA) or at least biphasic Doppler signal and ankle-brachial systolic index (ABSI) more than 0.70. Other demographic data as well as hematological, inflammatory, and biochemical parameters that may affect wound healing such as Hb, HbA1c, ESR, CRP, WBC, and albumin were recorded as well. The rate and time for wound healing and bone union, presence of complications, and final ambulatory status of patients were determined as the outcome of this study. Results: All of the patients had diabetic foot infections involving only the forefoot region with the presence of either palpable PTA or biphasic Doppler signal. Although the majority of the cases had deranged blood parameters, soft tissue and bone healing were achieved at variable times. Four had good outcomes as they were able to ambulate. One case was complicated with chronic wound dehiscence and another one had Pirogoff stump infection and required transtibial amputation. Conclusion: With strict selection criteria, Pirogoff amputation may provide a good functional outcome with a lesser degree of complications compared to major amputation. Cureus 2023-09-28 /pmc/articles/PMC10613117/ /pubmed/37905257 http://dx.doi.org/10.7759/cureus.46156 Text en Copyright © 2023, Tunku Zainudin et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Orthopedics
Tunku Zainudin, Tunku Naziha
Nachimuthu, Maniventhan
Ibrahim, Mohammad Izani
Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series
title Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series
title_full Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series
title_fullStr Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series
title_full_unstemmed Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series
title_short Outcome of Modified Pirogoff Amputation for Diabetic Foot Infection: A Single-Center Case Series
title_sort outcome of modified pirogoff amputation for diabetic foot infection: a single-center case series
topic Orthopedics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613117/
https://www.ncbi.nlm.nih.gov/pubmed/37905257
http://dx.doi.org/10.7759/cureus.46156
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