Guillotine Amputation Preceding Major Amputation is Protective Against Infectious Complications and Long-Term Amputation Failure in Lower Extremity Chronic Wound Patients
Kevin G. Kim, BS1; Landon P. Frazier, BS2; Paige K. Dekker, BA1; Aleek A. Aintablian, MS2; Kenneth L. Fan, MD1; Christopher E. Attinger, MD1; Karen K. Evans, MD1
1Department of Plastic & Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC; 2Georgetown University School of Medicine, Washington, DC
Background: Infection of lower extremity (LE) chronic wounds is a detrimental complication, often requiring major amputation. For severely infected wounds, a guillotine amputation performed prior to definitive amputation can help control infection and maximize success of subsequent major amputation. The short-term advantages of a two-stage approach have been demonstrated, however long-term outcomes have yet to be evaluated. This study aims to assess the effect of guillotine amputation on rates of long-term success of major amputation.
Methods and Analysis: A retrospective review of all major LE amputations for chronic and/or infected wounds performed January 2017-July 2020 at our tertiary wound center was conducted. Patients who were lost to follow up or who expired during the study period, as well as patients undergoing amputation for trauma, chronic pain, a non-infected limb deformity, or cancer, were excluded. Patient characteristics, preoperative labs, and amputation data were collected. Postoperative outcomes included hematoma, dehiscence, infection, and infection requiring takeback to the operating room (OR). Other outcomes of interest included stump revision, time to complete healing, and amputation failure, which was defined as failure to heal or need for more proximal amputation. Patients were separated into guillotine and no guillotine amputation groups.. Statistical analysis was performed to compare patient characteristics and amputation outcomes between groups.
Results: 193 patients meeting inclusion criteria were identified. 139 underwent guillotine amputation prior to definitive major amputation; 54 did not. Demographics, comorbidities, relevant preoperative labs, and amputation location were not statistically different between the two groups. The guillotine group had significantly decreased rates of infection (7.19% vs 22.22%, p=0.003), infection requiring takeback to OR (4.32% vs 20.37%, p<0.001), stump revision (2.88% vs 10.91%, p=0.032), and amputation failure (4.32% vs 12.73%, p=0.035) compared to the no guillotine group(Table 1). Rates of hematoma, dehiscence, and time to healing for successful amputations were similar between groups. Follow up was similar between groups (15.07 vs 14.33 months, p=0.445).
Conclusion: These results suggest guillotine amputation prior to definitive major amputation plays a significant role in limiting the spread of infection, resulting in decreased infectious complications and improved success rates, compared to single-stage major amputations. A two-stage approach also decreases the need to return to the OR for infection or stump revision. Guillotine amputations should be considered in the setting of infected chronic lower extremity wounds to improve long-term patient outcomes.
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