Name of the Procedure:

Ankle Disarticulation

• Common names: Syme's amputation
• Technical term: Ankle disarticulation

Summary

Ankle disarticulation is a surgical procedure where the foot is removed at the level of the ankle joint while preserving the heel pad to enable weight-bearing. It is a form of amputation that aims to maintain as much functionality of the limb as possible.

Purpose

• Addresses severe trauma, infection, or disease (e.g., diabetes, peripheral artery disease).
• Aims to remove the source of pain or infection and facilitate the use of a prosthetic limb.
• Expected outcomes include improved mobility, pain relief, and prevention of further complications.

Indications

• Severe injury or trauma to the foot
• Non-healing diabetic ulcers or infections
• Foot gangrene
• Unmanageable pain
• Congenital deformities
• Peripheral vascular disease leading to necrosis

Preparation

• Pre-procedure instructions include fasting for 8 hours and stopping certain medications (e.g., blood thinners).
• Diagnostic tests: Blood work, X-rays, MRI, or CT scans to assess the extent of damage.
• Physical examination and consultation with the surgical and anesthesiology teams.

Procedure Description

1. Anesthesia: General or spinal anesthesia is administered for pain control.
2. Incision: A circular incision is made around the ankle joint.
3. Disarticulation: The surgeon carefully separates the foot from the tibia and fibula at the joint, preserving the heel pad for future weight-bearing.
4. Hemostasis: Blood vessels are sealed to prevent bleeding.
5. Closure: The heel pad is attached to the residual limb stump to create a weight-bearing surface.

Tools/Equipment: Scalpels, special amputation saws, cautery devices, sutures, and surgical dressings.

Duration

The procedure typically takes about 2 to 3 hours.

Setting

Performed in a hospital surgical suite under sterile conditions.

Personnel

• Orthopedic or vascular surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Poor wound healing
• Phantom limb pain
• Residual limb complications (e.g., poor fitting for prosthetics)

Benefits

• Pain relief and removal of infected or necrotic tissue
• Improved ability to use a prosthetic limb for better mobility
• Potentially quicker recovery compared to other types of amputation

Recovery

• Hospital stay of 1-3 days post-surgery
• Wound care and monitoring for infection
• Physical therapy to adapt to using the residual limb and prosthetic fitting in 6-8 weeks
• Expected recovery time is around 4-6 months
• Follow-up appointments with the surgical and rehabilitation team

Alternatives

• Below-knee amputation: Involves removing the leg below the knee for severe cases, allowing for a more functional prosthetic fit.
• Conservative treatments: Including antibiotics, debridement, or reconstructive surgeries.
• Each alternative has pros and cons regarding recovery time, functionality, and suitability for the patient's specific condition.

Patient Experience

• During: The patient will be under anesthesia and will not feel pain or discomfort during the procedure.
• After: Expect some pain and swelling, managed with medications.
• Regular monitoring for signs of infection or complications.
• Encouraged to participate in rehabilitation to regain mobility and adapt to prosthetic use.
• Emotional support and counseling might be necessary to adjust to life post-amputation.