title: Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison.
abstract: The purpose of this study is to compare the long-term clinical outcomes of patients who were treated with either hind foot reconstruction or amputation in complex hind foot injuries accompanied with bone and soft tissue loss due to land-mine explosions. Between 1994 and 2004, all patients with hind foot complex injuries due to land-mine explosion, who were operated in our clinic, were enrolled to the study. All patients were evaluated with Short-Form 36 (SF-36), Foot and Ankle Disability Index (FADI) and Body Image Quality of Life Inventory (BIQLI) after a mean of 15.1 ± 2.2 (range 9-19) years of follow-up. Demographic characteristics, number of operations, necessity of psychiatric treatment and all complications were compared between groups. There were a total of 42 patients [21 in reconstruction group (Gr I) and 21 in amputation group (Gr II)]. The mean age at the time of final follow-up was 38.4 ± 3.04 years in Gr I and 38.2 ± 4.24 years in Gr II (p = 0.732). The mean follow-up duration was 15.7 ± 2.07 years in Gr I and 14.57 ± 2.29 years in Gr II (p = 0.081). The number of operations was significantly higher in Gr I (8.66 ± 10.2 times vs. 4.42 ± 7.7 times, respectively, p = 0.001). The mean FADI score at the final follow-up was 64.3 ± 18.1 in Gr I. In amputation group, more patients needed psychotherapy due to major depression (12 patients vs. 4 patients, p = 0.012). Major complications in Gr I were musculocutaneous flap atrophy in calcaneal region (n = 8 patients), limited ankle motion (n = 11) and painful osteophytes on plantar region (n = 6). In Gr II, stump problems were dominating (pain and tenderness n = 10, ulcer n = 2, allergic skin lesions n = 7, painful neuroma n = 10, bony spur n = 5, paresthesia n = 1, excessive sweating n = 12). At the final visit, although SF-36 scores were similar between groups (p = 0.182), extremity reconstruction group had significantly higher BIQLI scores than the amputation group (p = 0.016). If the dorsalis pedis is intact and midfoot and forefoot is relatively protected, hind foot reconstruction should be attempted. Long-term outcomes of hind foot reconstruction are satisfactory with minor complications and better BIQLI.
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Medipol University, Istanbul, Turkey.
authors.forename: Bahtiyar
authors.initials: B
authors.lastname: Demiralp
authors.forename: Tolga
authors.initials: T
authors.lastname: Ege
authors.forename: Ozkan
authors.initials: O
authors.lastname: Kose
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Yurttas
authors.forename: Mustafa
authors.initials: M
authors.lastname: Basbozkurt
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D018771:Arthralgia / Q000209:etiology; D001753:Blast Injuries / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D002111:Calcaneus / Q000293:injuries / Q000601:surgery; D003865:Major Depressive Disorder / Q000209:etiology; D004185:Disability Evaluation; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D006365:Heel / Q000293:injuries / Q000601:surgery; D006801:Humans; D018889:Ilizarov Technique; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods*; D008297:Male; D054850:Osteophyte / Q000209:etiology; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult