title: [Modified Pirogoff's amputation].
abstract: OBJECTIVE
  The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel.
  
  
  METHODS
  Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities.
  
  
  METHODS
  Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel.
  
  
  METHODS
  The incision runs from dorsal, 1-2 cm distal of the Chopart joint, to plantar, 5-6 cm distal of the Chopart joint for creation of an adequate plantar skin flap. Exarticulation of the foot from dorsal to plantar through the Chopart joint with preservation of the posteromedial neurovascular bundle. Enucleation of the talus. Minimal resection of the cuboidal and posterior facets of the calcaneus as well as the malleoli inclusive of the distal tibial joint surface. The calcaneus is brought under the tibia and a tibiocalcaneal arthrodesis is performed with two compression screws.
  
  
  METHODS
  No weight bearing until stable scar formation, early mobilization in a walker. Interim prosthesis after 2-4 weeks and definitive prosthesis after 2-3 months.
  
  
  RESULTS
  From January 2010 to December 2014 six patients were treated with a modified Pirogoff's amputation. Primary wound healing was achieved in four patients and in two patients wound healing was impaired. In one patient the wound was conservatively healed and the other patient needed below knee amputation. Early primary prosthetic treatment was possible in four patients. The tibiocalcaneal arthrodesis healed in all five remaining cases. All patients with a healed Pirogoff stump were able to walk for short distances in bare feet without the prosthesis.
authors.affiliation: Abteilung für Orthopädie und Unfallchirurgie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland. bernd.kinner@rbk.de.
authors.forename: B
authors.initials: B
authors.lastname: Kinner
authors.affiliation: Zentrum für Ambulante Rehabilitation, Regensburg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Roll
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D017719:Diabetic Foot / Q000175:diagnosis* / Q000601:surgery*; D005528:Foot / Q000601:surgery*; D006801:Humans; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Arthrodesis; Calcaneus; Foot; Hindfoot; Orthopedic procedures