title: A reliable surgical approach for the two-staged amputation in unsalvageable limb and life threatening acute progressive diabetic foot infections: tibiotalar disarticulation with vertical crural incisions and secondary transtibial amputation.
abstract: BACKGROUND
  If all efforts to treat acute progressive diabetic foot infection remain insufficient, the decision of major amputation should be undertaken. For this purpose, guillotine amputation is usually performed first. However, guillotine amputation below the knee level may cause the corresponding infection to spread to preserved anatomical spaces.
  
  
  METHODS
  First stage of our procedure consists of tibiotalar disarticulation and vertical incisions performed throughout the lower leg to remove the septic foot and drain the compartments. During the interval period, appropriate antibiotherapy and wound care are applied. After the interval period, definitive transtibial amputation is performed in the second stage.
  
  
  RESULTS
  Fifty-nine percent of the 62 transtibial amputations were healed completely. Failure developed in 3 cases which required opening of the amputation stump. In one patient, revision amputation at a higher transtibial level was done. Infection and necrosis reached to the knee joint in the other two patients and transfemoral amputation became the only treatment option for these 2 cases.
  
  
  CONCLUSIONS
  Tibiotalar disarticulation with vertical lower leg incisions as a first stage of two-stage transtibial amputation is a safe and reliable method. It reduces the risk of unnecessary tissue sacrifice and failure rate of the secondary transtibial amputation.
authors.affiliation: Istanbul University Cerrahpasa Medical School, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Altindas
authors.forename: Ali
authors.initials: A
authors.lastname: Kilic
authors.forename: Can
authors.initials: C
authors.lastname: Cinar
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D000672:Amputation Stumps; D001424:Bacterial Infections / Q000601:surgery*; D017719:Diabetic Foot / Q000601:surgery*; D004188:Disarticulation / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005534:Foot Diseases / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D013640:Tarsal Joints / Q000601:surgery*; D013977:Tibia / Q000601:surgery*