Editing Lower extremity amputation operatives (section)

== Midfoot and hindfoot amputations ==

* Considerations:
** Note that many surgeons recommend BKA as next step from TMA
** Results in dramatically altered foot biomechanics
** Short-leg plaster cast applied over the sterile dressings on the operating room table, and changed weekly
** Weight bearing after 4-6 weeks
* Lisfranc tarsometatarsal disarticulation
** See below for incision
** First, third, fourth and fifth TMTJs are diarticulated
** Second metatarsal divided 1-2cm distal to the medial cuneiform
** Variation - preserve the base of the fifth metatarsal and the insertion of peroneus brevis to prevent equinovarus deformity
** Achilles tendon released by either transection or Z-plasty
** Plantar fascia on the flap approximated to the dorsal periosteum with absorbable sutures
** Skin closed
* Chopart midfoot amputation
** Performed through talocalcaneonavicular joint and the calcaneocuboid joint
** Achilles tenectomy recommended
** EHL and tibialis anterior tendons reattached to talar neck
** EDL reattached to calcaneus
* Syme amputation
** Advantage is the preservation of limb length - can sometimes get away without a prosthesis for short periods of weight-bearing
** Less cosmetically-appealing prosthesis than for a BKA