Lisfranc amputation

A 50-year-old man with a history of IV drug abuse and type 2 diabetes underwent amputation of his right 2nd toe and was referred to us for surgical management of his infected right foot. Examination revealed several draining ulcers and sinus tracts, extending from the site of his amputated 2nd toe, to beneath the 2nd and 3rd metatarsal heads and into the central plantar space (Fig. 8.33a). Radiographs revealed osteolytic changes in the 2nd and 3rd metatarsals consistent with osteomyelitis. The patient was given the options of a partial foot amputation or below-knee amputation, and he chose to preserve his leg. He was taken to the operating theatre where under spinal anaesthesia and ankle tourniquet, he underwent a Lisfranc amputation of his right foot (Fig. 8.33b). The technical difficulty in this case was related to the poor condition of the plantar skin. We were unable to fashion a healthy long plantar flap. Closure was accomplished by creating a slightly longer dorsal flap. The surgical wound healed satisfactorily (Fig. 8.33c,d). The Achilles tendon was not lengthened in this case, and a mild equinovarus deformity developed. The right foot held up well, for approximately 9 years, until the patient developed a new ulcer and recurrent infections. He unfortunately went on to a below-knee amputation.

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