A Complete Guideline About Guillotine Ankle Amputation:

 

Overview:

Guillotine ankle amputation is a surgical procedure in which surgeons remove the ankle and foot joint. This procedure is typically performed as a last option in cases of infection, severe trauma, or advanced peripheral vascular disease. The prime goal of guillotine ankle amputation is to remove infected or injured tissue to stop the spread of infection and to improve the patient's quality of life and overall health.

Guillotine ankle amputation is crucial due to its potential to save the patient's life by preventing the spread of infection to the rest of the body. The removal of affected tissue through this procedure can also alleviate pain and enhance the patient's mobility and functionality. Furthermore, guillotine ankle amputation may be a necessary step in preparing the affected limb for prosthetic fitting and rehabilitation.

What is the Guillotine Ankle Amputation Technique?

Guillotine ankle amputation is a surgical procedure where the foot is removed by making a circular cut around the ankle without creating a flap of skin to cover the wound right away. This technique is often used in emergencies or when there is a high risk of infection. The wound is left open and closed during a second surgery. It allows for quick removal of the foot while minimizing the time the patient is under anesthesia.

History of Amputation:

Cutting off a body part, called amputation, is one of the oldest surgeries people know about. It has been done for religious reasons, to help with healing, and as a punishment. According to most of the writing from the last 50 years, land mines are the most common reason for people losing limbs in war^1.

How does guillotine ankle amputation perform?

Guillotine ankle amputation is crucial for quick limb removal in emergencies, minimizing anesthesia time and infection risk. This procedure involves surgical steps including:

Preparing for Lower Limb Amputation Surgery

1. Patient Positioning and Preoperative Medication

The patient is lying on their back on the operating table in preparation for the surgery.

If the patient is not undergoing antimicrobial treatment, a preventive antibiotic dose is given to decrease the likelihood of an infection. Prophylaxis against deep vein thrombosis is considered to prevent blood clots and mechanical or chemical modalities are initiated if required.

2. Preparation of the Foot and Leg:

To avoid infection, any open ulcers on the foot are covered with a dressing soaked in povidone-iodine. The foot is then wrapped with an impervious stockinette and secured with a bandage, such as Coban, to protect it during the surgery. The extremity is cleaned with antiseptic solutions, and the part of the leg from the knee to just below the malleoli is uncovered in a sterile field, while the remainder is covered with sterile drapes.

3. Surgical Procedure:

To prepare for the amputation, a circumferential incision is made at the narrowest section of the ankle, cutting through the skin and soft tissues to the bone. The nerves are severed with a scalpel to minimize damage to the surrounding tissues, instead of being crushed with scissors. Careful hemostasis of all vessels, including small vessels in the stump, is ensured while dividing the distal tibia and fibula with a Gigli saw to control bleeding.

4. Post-Surgical Care:

After the surgical procedure, the tourniquet is released, and the surgical team checks for hemostasis to confirm that the bleeding is under control. The wound is cleaned with saline, and the end of the stump is covered with dry, fine-mesh gauze to protect it as the patient begins to recover.

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Recovery:

What is the recovery time after an amputation?

The recovery time after an amputation depends on:

1. The complexity of the surgery
2. The limb patient had been amputated.
3. Whether or not the patient is using a prosthetic limb

The patients will learn to use the limb about two months after surgery. This learning process may take two to six months.

As the patient becomes more active, remember that learning to function and move without a natural limb can be a lengthy process. It’s better to stay in touch with a healthcare provider to manage any issues that come up.

Benefits:

What are the benefits of guillotine ankle amputation?

Guillotine ankle amputation, which involves removing the foot and part of the leg at the ankle joint, is typically performed in emergencies, such as severe trauma or infection. Some potential benefits of this procedure include:

• A rapid removal of infected or rigorously injured tissue can assist prevent the spread of infection to other parts of the body.
• Relief from severe pain or trauma in the affected area
• Facilitation of quicker wound healing and rehabilitation compared to more extensive amputation procedures.

It's important to note that while guillotine ankle amputation may offer these benefits in certain urgent medical situations, the decision to perform this procedure should be carefully evaluated by medical professionals based on the patient's specific condition and needs.

Risks:

What are the risks of guillotine ankle amputation?

The risks of guillotine ankle amputation include:

• Infection
• Delayed wound healing
• Nerve damage
• Potential revision surgeries for closure

Revision surgeries can pose further risks and complications for the patient.

Research Insights about Guillotine Ankle Amputation Technique:

1. When disarticulation amputation is done correctly, it helps stabilize the remaining limb. In our experience, a definitive amputation can be done within a few days. Before the definitive amputation, it's important to make sure the patient is stable and medically optimized for the best chance of healing well.

This approach requires a team of different specialists who converse well to consistently achieve good results and functional remaining limbs. Dr. Borkosky and Dr. Donnenwerth are first-year residents in the Surgery and Podiatric Medicine program at Gundersen Lutheran Medical Center^2.

2. Guillotine amputation before definitive major amputation is important for reducing the spread of infection, leading to fewer infection-related issues and better success rates after major amputation, compared to doing a major amputation in a single stage. A two-stage approach also helps reduce the need for additional surgeries due to infection or stump revision. Guillotine amputations should be thought about for infected long-term lower limb wounds to improve patient outcomes in the long run³.

3. As of 2014, around 422 million people worldwide are estimated to have diabetes. It's well known that diabetes-related lower limb amputations have a high risk of mortality around the time of the operation. This article uses the case of a 62-year-old woman with poorly controlled diabetes who got necrotizing fasciitis in her lower limb and had a body-wide infection to show how the procedure is done. It's important to know how to do this operation because it's very effective at quickly getting rid of a source of foot infection⁴.

Will the patient remain critically ill after guillotine ankle amputation?

Healthcare providers can clean the remaining guillotine amputation site at the bedside in a simple way under clean conditions and put PMMA beads in the site every day until the final amputation at a functional level can happen. When there are life-threatening foot infections, doing the amputation in stages creates the best situation for saving a functional knee joint.

What are the signs of infection of a stump?

Signs of infection in a stump can include:

• Redness, warmth, or swelling around the stump
• Increased pain or tenderness at the stump site
• Pus or discharge from the wound
• A foul odor coming from the wound
• Fever or chills
• Increased sensitivity or discomfort
• Delayed healing or reopening of the wound

If you experience any of these signs, it's crucial to get medical attention promptly for proper evaluation and treatment.

What are the types of amputation?

The main types of amputation include:

1. Partial foot amputation: Involves removing part of the foot, such as the toes or part of the forefoot.
2. Transtibial (below-knee) amputation: Involves removing the lower leg below the knee.
3. Transfemoral (above-knee) amputation: Involves removing the leg above the knee.
4. Partial hand amputation: Involves removing part of the hand, such as fingers or part of the palm.
5. Transradial (below-elbow) amputation: Involves removing the forearm below the elbow.
6. Transhumeral (above-elbow) amputation: Involves removing the arm above the elbow.
7. Toe or finger amputation: Involves removing one or more toes or fingers.

These are some of the common types of amputation, each with its specific considerations for rehabilitation and prosthetic fitting.

How do surgeons perform guillotine amputations on the ankle without using a tourniquet?

Surgeons can perform guillotine amputations on the ankle without needing a tourniquet. They use specific techniques to limit blood loss and maintain a "no touch" approach. The surgeon determines the appropriate level of disarticulation based on the extent of infection, carefully considering infected, nonviable, and necrotic tissue. The procedure involves systematic dissection, identification, and management of vascular and neurological structures, and irrigation. The entire process, from initial incision to final dressing, takes about 20 minutes for a transmetatarsal-phalangeal joint disarticulation and 40 minutes for an ankle disarticulation.

Conclusion:

When disarticulation amputation is done correctly, it helps stabilize the remaining limb. In our experience, a definitive amputation can be done within a few days. Before the definitive amputation, it's important to make sure the patient is stable and medically optimized for the best chance of healing well. This method needs a team of different specialists who communicate well to consistently achieve good results and functional remaining limbs.