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The Role of Isolated Profundaplasty in Attempts to Lower the Level of Amputation in Critical Limb Ischemia

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Cnotliwy M., Szumiłowicz J., Safranow K., Petriczko W., Wiernicki I., Gutowski P.

Polish Journal of Surgery

2007

vol. 79

issue 12

773-778

The aim of the study was to verify the usefulness of isolated profundaplasty performed prior to amputation in attempts to salvage the knee joint in patients scheduled for the major amputation due to critical limb ischemia.Material and methods. The study enrolled 46 patients treated between January 1992 and December 2005 due to critical limb ischemia who were primarily scheduled for major amputation. Arteriography performed in all studied patients disqualified these patients from attempts to reconstruct the lower leg arteries, but simultaneously provided information on possibilities for profunda repair. A few days prior to below-knee amputation, a profundaplasty was performed. The following parameters were evaluated: the course of wound healing in the groin and tibial stump, the rate of conversion of the transtibial amputation to an above-knee amputation and patency of the deep femoral artery 12 months postoperatively.Results. One patient died within the first 30 postoperative days. Complications of wound healing in the groin requiring surgical debridement occurred in 7 patients. Early conversion to above-knee amputation was necessary in 10 cases due to lack of stump healing; this group included 6 patients with infected pedal tissue necrosis and 4 patients with reocclusion of the deep femoral artery. The cumulative proportion of survivors at 12 months with a preserved knee joint was 0.50, and that of those with a patent deep femoral artery was 0.47. No significant differences were found between profundaplasty methods regarding patency of the deep femoral artery and tibial stump healing. Similarly, no significant differences were found between diabetic and non-diabetic patients. It has been found that infection of pedal tissue necrosis had a significant negative influence on the patency of the deep femoral artery following the profundaplasty (p=0.02) and resulted in lower rates of salvage of the knee joint (p=0.0002)Conclusions. 1. In the case when other methods of vascular reconstruction are no longer possible, an isolated profundoplasty performed prior to below-knee amputation creates a chance for stump healing and salvage of the knee joint for the patients with critical limb ischemia who have no infection within the foot. 2. Pedal tissue infection in the same group of patients should constitute an indication for primary above-knee amputation.

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1 Polish Journal of Surgery

1 2007

1 Cnotliwy M.

1 Gutowski P.

1 Petriczko W.

1 Safranow K.

1 Szumiłowicz J.

1 Wiernicki I.

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The Role of Isolated Profundaplasty in Attempts to Lower the Level of Amputation in Critical Limb Ischemia