Summary
In 35 patients suffering from peripheral ischemic disease of the legs, disarticulation of the knee joint was performed instead of above-knee amputation. Operations were executed primarily or after failed bypass procedures for the salvation of the limb. 24 cases (67%) showed primary or delayed secondary stump healing. In 11 cases (31%), however, no stump healing was achieved due to either a wound infection (4 cases) or a necrosis of the anterior flap covering the weight bearing area of the stump (7 cases). Factors influencing the outcome of stump healing are discussed and different techniques of knee disarticulation are evaluated as to their benefits and disadvantages in ischemic limbs. As the method offers several advantages over above-knee amputation, a more frequent use of knee disarticulation in the surgical treatment of ischemic legs which cannot be preserved by other surgical measures and usually would be amputated at above-knee level is recommended.
Zusammenfassung
Bei 35 Patienten mit arteriellen Durchblutungsstörungen der unteren Extremitäten wurde primär oder nach erfolgloser Bypassoperation anstelle einer Oberschenkelamputation eine Exarticulation im Kniegelenk durchgeführt. Davon heilten 24 (67%) primär oder teils sekundär, 11 (31 %) zeigten keine Abheilung des Stumpfes. 4 Wundinfektionen und 7 Nekrosen des stumpfdeckenden Hautsubcutislappens waren die Ursache. Mögliche Einflüsse auf das Ergebnis der Stumpfheilung werden anhand unterschiedlicher Operationstechniken diskutiert. Da die Knieexarticulation der Oberschenkelamputation deutlich überlegen ist, wird aufgrund der hier aufgeführten Untersuchungsergebnisse diese Methode favorisiert.
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Meyer, H.H., Walterbusch, G. & Brenner, P. Die Kniegelenksexarticulation bei arteriellen Durchblutungsstörungen der unteren Extremität. Langenbecks Arch Chiv 367, 87–98 (1986). https://doi.org/10.1007/BF01259257
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DOI: https://doi.org/10.1007/BF01259257