Utilizing threaded steinmann pins to resect the talus and calcaneus for ankle joint disarticulation (Syme's procedure)

Abstract

Syme, in 1843, was the first to describe ankle joint disarticulation preserving the heel pad. This amputation level has advantages over Lisfranc's amputation (tarsometatarsal disarticulation) and Chopart' s amputation (talonavicular/calcaneocubiod disarticulation). The major advantage of the Syrne's amputation includes decreased energy consumption and smoother gait during ambulation. Another advantage is that the other midfoot/hindfoot disarticulations are prone to soft-tissue breakdown on the plantar-lateral aspect of the stump. This is a result of the muscular imbalance that occurs due to the disruption of the tendinous insertions of the anterior musculature and subsequent overpowering of the posterior musculature. Despite these advantages, the Syme's procedure is often avoided because of the technical difficulties associated with its performance. There are two critical steps in the Syme's amputation that ultimately determine the success of the procedure. The first critical step is preservation of the posterior tibial artery at the distal aspect of the plantar flap. This artery will serve as the major blood supply to the plantar flap, and care must be taken to avoid injury of this vessel during dissection of the medial ankle joint ligaments. The second critical step is preservation of the heel pad during dissection of the talus and calcaneus. Dissection of the talus and