Fig. 8.33 Lisfranc amputation, (a) Initial presentation with a non-healing wound at the site of prior amputation of the 2nd toe, right foot, (b) Multiple draining plantar ulcers with sinus tracts, (c) Completed repair with a long dorsal flap and short plantar flap, (d) Healed Lisfranc amputation right foot, compared to transmetatarsal amputation of the left foot. Part (d) from Sanders (1997) with permission from Elsevier Science.
underwent a Chopart's amputation of his left foot. In an effort to prevent the development of ankle equinus, the tibialis anterior and extensor digitorum longus tendons were attached to the residual neck of the talus. In addition, the Achilles tendon was tenotomized. A small split-thickness skin graft was applied to the wound for coverage. The operative sites were bandaged and the foot was placed in a well-padded posterior splint. The patient was seen by an orthotist/prosthetist who provided a temporary clamshell total-contact cast.
In spite of our efforts to prevent the development of ankle equinus, this occurred, and was complicated by the
development of ulceration. The patient ambulates well, and appears to be satisfied with the outcome of his surgery (Fig. 8.34a,b).
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