Leprosy mailing
list – April 2nd, 2005
Ccn: all.
Ref.: Indications
for amputation in complicated chronic ulcer.
From:
A Salafia
,
Mumbai
,
India
.
Dear
Salvatore,
This is a
rejoinder to the letters of S Kingsley (LML March 26th, 2005)
and
G. Warren
(LML March 30th,
2005).
I totally
agree with Dr. Warren, who is an experienced surgeon. Mr. Kingsley is
a physiotherapist and I personally believe he has ‘overstepped his
brief’ by making bold comments on surgery.
As you know I
am a trained Hand Surgeon and my co-worker is an Orthopaedic Surgeon
(Dr. G. Chauhan). We have done hundreds of ‘corrective osteotomies’
even in cases of Charcot of the foot, and very few amputations. We –
on the example of Dr. Warren- try to save a limb for as long as
possible, even when everybody else says “amputate”.
I just want
to add a few words to what Dr. Warren has so clearly explained:
1.
Whenever the
sole of the foot is good, we try and try again to save the foot.
2.
If however
the sole is scarred beyond repair and there is and extensive infection
– at time compounded with diabetes- involving bones and soft tissue,
then we opt for below knee (BK) amputation; but this is a very rare
case; the fact is that while we may be doing about 30-40 corrective
osteotomies in a year, we do 1 BK amputation in a year.
3.
We have badly
deformed feet (like in case of Charcot) by doing a Talectomy and
fusion (with the help of Charnley clamps). In a couple of case we have
used the Iliazarov system for a correct alignment of the foot, with
good results.
In other
words, we agree with Dr. Warren that a foot should be saved at all
costs; only when this is not humanly possible, we opt for a BK
amputation.
Bets regards,
Antonio
