Syme Amputation: A Systematic Review

Braaksma, Rudwina; Dijkstra, Pieter U.; Geertzen, Joannes

doi:10.1177/1071100717745313

Cited by 19 publications

(6 citation statements)

References 38 publications

(74 reference statements)

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“…17 In our study, 25% of Syme amputations later required a major amputation, which is in the range described in the previous literature (14.7%-38.5%). 7,17,19 Although most of our major amputations were due to DFO located in the forefoot, this occurred in 6% of forefoot DFO cases. Moon et al observed that 4.7% of forefoot ulcers in the setting of diabetes mellitus underwent later major amputation.…”

Section: Discussionmentioning

confidence: 96%

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Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes

et al. 2022

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Background: Diabetic foot osteomyelitis (DFO) often leads to amputations in the lower extremity. Data on the influence of the initial anatomical DFO localization on ultimate major amputation are limited. Methods: In this retrospective analysis, 583 amputation episodes in 344 patients (78 females, 266 males) were analyzed. All received a form of amputation in combination with antibiotic therapy. A multivariate logistic regression analysis with the primary outcome “major amputation” defined as an amputation above the ankle joint was performed. The association of risk factors including location of DFO, coronary artery disease, peripheral artery disease, neuropathy, nephropathy, and Charcot neuro-osteoarthropathy was analyzed. Results: Among 583 episodes, DFO was located in the forefoot in 512 (87.8%), in the midfoot in 43 (7.4%), and in the hindfoot in 28 episodes (4.8%). Overall, 53 of 63 (84.1%) major amputations were performed because of DFO in the setting of peripheral artery disease as primary indication. Overall, limb loss occurred in 6.1% (31/512) of forefoot, 20.9% (9/43) of midfoot, and 46.4% (13/28) of hindfoot DFO. Among these, 22 (41.5%) were performed as the primary treatment, whereas 31 (58.5%) followed previously failed minor amputations. Among this latter group of secondary major amputations, the DFO was localized to the forefoot in 23 of 583 (3.9%), the midfoot in 4 of 583 (0.7%) and the hindfoot in 4 of 583 (0.7%). In multivariate logistic regression analysis, initial hindfoot localization was a significant factor ( P < .05), whereas peripheral artery disease, smoking, and a midfoot DFO were not found to be risk factors. Conclusion: In our retrospective series, the frequency of limb loss in DFO increased with more proximal initial foot DFO lesions, with almost half of patients losing their limbs with a hindfoot DFO. Level of Evidence: Level IV, retrospective cohort study.

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Section: Discussionmentioning

confidence: 96%

“… 17 In our study, 25% of Syme amputations later required a major amputation, which is in the range described in the previous literature (14.7%-38.5%). 7 , 17 , 19 …”

Section: Discussionmentioning

confidence: 99%

Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes

et al. 2022

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“…Most reports on these amputation levels have focused on patients with diabetes, peripheral vascular disease, infections, or tumors. While there are several small series and case reports in the literature on hind-and midfoot amputations for trauma, the heterogeneous injury types, surgical techniques, and reported outcome measures, and the small patient numbers without comparison groups make it difficult to interpret prior reports [23][24][25][26][27][28][29] . Our study was an attempt to compare outcomes of patients undergoing hind-and midfoot versus transtibial amputations after traumatic injury.…”

Section: Discussionmentioning

confidence: 99%

Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?

Fram,

Bosse,

Odum

et al. 2024

Journal of Bone and Joint Surgery

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Background: The purpose of this study was to compare 18-month clinical and patient-reported outcomes between patients with severe lower-limb injuries treated with a transtibial amputation or a hind- or midfoot amputation. Despite the theoretical benefits of hind- and midfoot-level amputation, we hypothesized that patients with transtibial amputations would report better function and have fewer complications. Methods: The study included patients 18 to 60 years of age who were treated with a transtibial amputation (n = 77) or a distal amputation (n = 17) and who were enrolled in the prospective, multicenter Outcomes Following Severe Distal Tibial, Ankle, and/or Foot Trauma (OUTLET) study. The primary outcome was the difference in Short Musculoskeletal Function Assessment (SMFA) scores, and secondary outcomes included pain, complications, amputation revision, and amputation healing. Results: There were no significant differences between patients with distal versus transtibial amputation in any of the domains of the SMFA: dysfunction index [distal versus transtibial], 31.2 versus 22.3 (p = 0.13); daily activities, 37.3 versus 26.0 (p = 0.17); emotional status, 41.4 versus 29.3 (p = 0.07); mobility, 36.5 versus 27.8 (p = 0.20); and bother index, 34.4 versus 23.6 (p = 0.14). Rates of complications requiring revision were higher for distal amputations but not significantly so (23.5% versus 13.3%; p = 0.28). One distal and no transtibial amputees required revision to a higher level (p = 0.18). A higher proportion of patients with distal compared with transtibial amputation required local surgical revision (17.7% versus 13.3%; p = 0.69). There was no significant difference between the distal and transtibial groups in scores on the Brief Pain Index at 18 months post-injury. Conclusions: Surgical complication rates did not differ significantly between patients who underwent transtibial versus hind- or midfoot amputation for severe lower-extremity injury. The average SMFA scores were higher (worse), although not significantly different, for patients undergoing distal compared with transtibial amputation, and more patients with distal amputation had a complication requiring surgical revision. Of note, more patients with distal amputation required closure with an atypical flap, which likely contributed to less favorable outcomes. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…When plantar skin is used in the reconstruction of residual limbs, it performs better than skin from other donor sites 16,17 . The Syme amputation, named after the surgeon who pioneered it, uses heel pads (including the skin and fat pad) to reconstruct the lower residual limb; these individuals can walk directly on their stumps without incurring skin injury 18 . However, plantar skin is rarely available in sufficient quantities when reconstructing residual limbs.…”

Section: Premisesmentioning

confidence: 99%

Can plantar fibroblast implantation protect amputees from skin injury? A recipe for skin augmentation

Boyle

2021

Experimental Dermatology

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Skin injuries remain a persistent problem for users of lower‐limb prostheses despite sustained progress in prosthesis design. One factor limiting the prevention of skin injuries is that skin on the residual limb is not suited to bear the mechanical loads of ambulation. One part of the body that is suited to this task is the sole of the foot. Here, we propose a novel strategy to actively augment skin's tolerance to load, increasing its resistance to mechanically induced injuries. We hypothesise that the load tolerance of skin can be augmented by autologous transplantation of plantar fibroblasts into the residual limb dermis. We expect that introducing plantar fibroblasts will induce the overlying keratinocytes to express plantar‐specific keratins leading to a tougher epidermis. Using a computational finite element model of a weight‐bearing residual limb, we estimate that skin deformation (a key driver of pressure ulcer injuries) could be halved by reprogramming skin to a plantar‐like phenotype. We believe this strategy could yield new progress in pressure ulcer prevention for amputees, facilitating rehabilitation and improving quality of life for patients.

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Syme Amputation: A Systematic Review

Abstract: Therapeutic Level III, systematic review containing retrospective cohort studies.

Cited by 19 publications

References 38 publications

Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes

Foot Osteomyelitis Location and Rates of Primary or Secondary Major Amputations in Patients With Diabetes

Do Transtibial Amputations Outperform Amputations of the Hind- and Midfoot Following Severe Limb Trauma?

Can plantar fibroblast implantation protect amputees from skin injury? A recipe for skin augmentation

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