Orthopedic surgeons must balance technology and clinical experience when considering amputation

BANFF, Canada — The causes of amputation have changed in the past 20 years as vascular disease amputations continue to rise. In 1990, a study revealed that vascular disease accounted for 70% of all amputations. In 2012, that number has increased to 82%.

“In spite of advances in vascular salvage, vascular disease is still a major issue as the population ages,” Robin Crandall, MD, limb deficiency director, Shriners Hospital for Children told the audience at this year’s Association of Children’s Prosthetics-Orthotics Clinics (ACPOC) meeting.

Trauma has actually been cut in half over that same period. Crandall noted that this was a combination of advances in limb salvage technique as well as improved safety advances in machinery.

Crandall explored the various lower extremity amputation levels selected by the surgical team from toe removal to knee disarticulation and transfemoral amputation. According to Crandall, most amputations are due to issues with the foot, especially if the individual is a diabetic. The first thing to do when a patient comes in with a foot issue is to decide if there is a bony deformity.

“Do not operate unless you know that the patient’s circulation can handle surgery,” he advised. “I’ve seen patients who have undergone surgery on their foot and they just turn into a big ulcer because they have no circulation to heal the wound.”

Whether a toe removal, new vascular techniques or knee disarticulation, it is the responsibility of the orthopedic surgeon to find a balance between advanced technology and their clinical experience when considering amputation, according to Crandall.

“Use the technology, but clinical judgment is so important,” Crandall said. “Right when that patient hits the emergency room with their trauma, have a game plan. Think of the skin, think of the residual limb. If you have a vascular patient, examine their lifestyle and try to make the decisions early, rather than later. Use your judgment.”


For more information:

Crandall R. Lower extremity amputation level selection. Presented at the Association of Children’s Prosthetics-Orthotics Clinics Annual Meeting. April 11-14. Banff, Canada.

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