Conversion of Failed Right Leg Below-Knee Amputation to Above-Knee Amputation for Severe Peripheral Arterial Disease
Faizaan Aziz1; Andrew Shevitz, DO2; Faisal Aziz, MD, MBA, FACS, DFSVS2
1University of Michigan
2Penn State Health Milton S. Hershey Medical Center
Patients with severe peripheral arterial disease and critical limb-threatening ischemia are at high risk for limb loss. This video presents a 76-year-old male with extensive comorbidities who underwent above-knee amputation after failed healing of a below-knee amputation. Despite patent inflow vessels, poor distal perfusion led to non-healing wounds. The patient tolerated the above-knee amputation well, with an uneventful recovery and discharge to rehabilitation on postoperative day five. This case illustrates the role of above-knee amputation in patients with severe peripheral arterial disease and non-healing below-knee amputation, emphasizing technical steps and perioperative management.
Left First Toe Amputation (Ray, Cadaver)
Laura Boitano, MD; Samuel Schwartz, MD
Massachusetts General Hospital
Minor lower extremity amputations typically involve either toe or ray resections. The first ray is an essential component in the normal anatomy and biomechanics of the foot. By definition, the first ray consists of the hallux and the first metatarsal. The surgical procedure discussed in this educational video is a left first toe ray amputation on a cadaver. Toe amputation is a significant predictor of future limb loss. Ray amputation appears to be preferred over finger amputation in selected cases. However, the literature does not provide precise indications on when to consider a ray over a toe amputation. The choice is therefore left to the operating surgeon, based on their clinical expertise and the patient’s conditions and expectations, taking into account the underlying pathology.
Left First Toe Amputation (Ray)
Harvard Medical School
Samuel Schwartz, MD
Assistant Professor of Surgery
Massachusetts General Hospital
Laura Boitano, MD
Resident Physician
Massachusetts General Hospital
In this case, Dr. Schwartz and Dr. Boitano perform a cadaveric demonstration of a first left toe ray amputation at Harvard Medical School.
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