Pirogoff Amputation with a Disappointing Outcome: A Case Report

Annelies Van Der Vegt,Maria A Paping,Joannes H.B Geertzen

doi:10.31487/j.scr.2020.02.01

Abstract

Case Presentation: A 53-year-old motorcyclist suffered trauma with an extensive foot injury. A Pirogoff amputation was performed. A hindfoot amputation might be considered as an alternative option rather than directly proceeding to a trans-tibial amputation. Results: A Pirogoff amputation was performed with a disappointing course afterward. Subsequently, we performed a literature search on the Pirogoff amputation. Conclusion: Further research is needed concerning the optimal amputation level for patients who need a hindfoot amputation since good studies are lacking. In general, a major advantage of the Pirogoff amputation is the possibility of some barefoot mobility. The disadvantages are fitting problems due to a bulbous stump and limited installation height for the incorporation of a prosthesis. A trans-tibial amputation might be considered in young and healthy patients because of the extensive possibilities for prosthetic fitting. The final decision of the amputation level should be made by an experienced surgical and rehabilitation team discussing the advantages and disadvantages with the patient involved. Currently, evidence from the literature is too limited to guide this discussion and the decision-making process.

Highlights

In the case of extensive foot lesions where the foot cannot be reconstructed, amputation at different levels can be performed
In case a distal partial foot amputation cannot be performed, a Pirogoff amputation might be considered among other procedures as an alternative option rather than directly proceeding to a major amputation, such as a trans-tibial amputation (TTA)
We present a case description of a patient who underwent a Pirogoff amputation after a traumatic injury and who encountered a difficult course afterward

Summary

Introduction

In the case of extensive foot lesions where the foot cannot be reconstructed, amputation at different levels can be performed. The selection of the adequate amputation level involves an assessment of the medical possibilities and consideration of possibilities for prosthetic fitting and expected mobility. In case a distal partial foot amputation cannot be performed, a Pirogoff amputation might be considered among other procedures as an alternative option rather than directly proceeding to a major amputation, such as a trans-tibial amputation (TTA). Indications for Pirogoff amputation include foot lesions that are too extensive for reconstruction or non-operative treatment [1, 3, 4]. Severe neuropathy and performance of this amputation on diabetic and dysvascular patients are (relatively) contraindicated [3]. Other authors show success rates in a selected group of patients [1, 4, 10]

Objectives

Findings

Discussion

Conclusion