Limb salvage surgery: The vascular surgeon versus the major amputation Cirugía de salvamento de extremidad: El cirujano vascular versus la amputación mayor

Abstract

This prospective study shows how between March 2001 and May 2004, seven patients were treated who consulted the Hospital de San José and the Clínica Fundadores in the city of Bogotá, Colombia, with ischemic lesions in the foot secondary to atherosclerotic occlusion of the infrapopliteal arteries. . Two of them had chronic renal failure, four were diabetic and one smoker for several years. The physical examination revealed ischemic lesions located on the foot and adequate popliteal pulse with absence of pedio and posterior tibial. All patients underwent an arteriographic study using the Seldinger technique, in which occlusion of the infrapopliteal arteries was confirmed. All were taken to surgical exploration under regional anesthesia, finding in four of them a good recipient bed at the Pedia artery level, so they underwent a popliteal-pedio graft with an inverted saphenous vein, and in the remaining three, a good bed at the level of the posterior tibial artery, so they underwent a popliteal-tibial graft, also with an inverted saphenous vein. The necrotic areas were then debrided. The postoperative follow-up showed that in the patients who underwent a popliteal-tibial graft, there was failure of the graft, two due to graft infection and another due to recurrent occlusion. In none of them was it possible to heal the lesions of the foot and finally one required infracondylar amputation and two supracondyles. In those in whom the pedia artery was revascularized, adequate permeability of the graft was observed with total healing of debrided areas after 90 days with recovery of the gait and total functionality of the limb. It is concluded that in these patients it is always necessary to try some revascularization procedure and it is the surgical exploration that ultimately defines this possibility, that although it is not always effective, allows to avoid major amputations in a significant number of cases, which translates in less work disability and better quality of life.