Retrospective review of nontraumatic lower extremity amputations

Post-amputation complications refer to problems that may arise during post-amputation care and rehabilitation as well as amputation surgery. Reamputation is the process of surgically amputating a previously amputated limb again after amputation. Wound healing problems or infections after the first amputation, poor wound healing as a result of inadequate circulation of the amputated area are the most common reasons for the need for reamputation. In our study, we aimed to retrospectively analyze the age, gender, side, etiology, level of amputation, number of days of hospitalization, cardiovascular intervention, hemogram, biochemistry, serology parameters, number and technique of surgical procedures applied to patients requiring repeated surgical procedures in patients who underwent lower extremity amputation for non-traumatic reasons between 2010-2023 in our clinic. In the direction of these data, it was aimed to examine the factors that could predict that patients may go to reamputation after amputation surgery. Changes in the parameters examined in repeated amputation surgeries were analyzed. It was aimed to investigate the optimal data for amputation surgery. Between 01/01/2013-01/01/2023, 314 patients who underwent lower extremity amputation surgery for non-traumatic reasons, peripheral arterial disease and/or microvascular disorders in our clinic were included in the study. Operative reports, imaging methods, anamnesis information, and laboratory results of the patients were retrospectively analyzed. In repeated amputation surgeries, the data of the patients before each amputation surgery were obtained in order to obtain the increasing or decreasing parameter before each surgery.203 patients who recovered without complications after the first amputation surgery were grouped as the control group (Group1). Patients who underwent more than one amputation surgery due to complications that developed after the first amputation surgery were considered as separate study groups. The data of the patients who underwent repeat surgeries before the first amputation surgery were analyzed and 111 patients were included in this group and named as the second group (Group 2). 104 patients who underwent the second reamputation surgery (ipsilateral third amputation surgery) due to complications after the first amputation surgery were named as group3 (Group 3). Thirty-two patients who underwent third reamputation surgery (ipsilateral fourth amputation surgery) due to complications after the first amputation surgery were named as group4 (Group 4). In addition, patients were also grouped according to the level of amputation and the effect of the choice of amputation level on reamputation was examined. The mean age of the 314 amputation patients included in our study was 69.20±12.18 (years), 234 patients (74.5%) were male and 80 patients (25.4%) were female.In our study, it was observed that peripheral vascular intervention (peripheral angioplasty/bypass) was performed in 127 (28.2%) of 450 amputation surgeries, aiming revascularization before amputation surgery. The rate of patients who underwent more than one amputation surgery due to complications after the first amputation surgery (Group 2; 111 patients) was 35.3%, the rate of patients who underwent the third amputation surgery due to complications after the first amputation surgery was 32.6%, and the rate of patients who underwent the fourth amputation surgery due to complications after the first amputation surgery was 10.1%. In our control group (Group1) who recovered without complications after the first amputation surgery, 48.8% of the amputation surgeries were performed at the distal ankle (Group A; toe, mtp joint disarticulation, trnasmetatarsal, lischfrank, chopart), 34.5% at the transtibial (Group B), 16.7% at the knee (Group C) level. In the group including patients who underwent more than one amputation surgery due to complications after the first amputation surgery (Group 2), 52.3% of the surgeries were performed at the distal ankle level (Group A), 32.4% at the transtibial level (Group B), and 15.3% at the knee level (Group C). In our study, there was no significant difference in Wbc, platelets, sedimentation, C-reactive protein, hematocrit, creatinine values between the group (Group1) who recovered without complications after the first amputation surgery and the group (Group2) including patients who underwent multiple amputation surgeries due to complications after the first amputation surgery. There is a need for studies to create individualized prediction models for amputation patients that can assess wound healing potential after lower extremity amputations for diabetic foot and/or peripheral vascular disease, help predict the risk of reamputation, and assist clinicians in deciding on the level of amputation.Current clinical algorithms used to predict the risk of healing failure have limitations and require a more individualized approach to decision making and the development of predictive data.