Name of the Procedure:

Amputation, foot; midtarsal (e.g., Chopart type procedure)

Summary

A midtarsal amputation, also known as a Chopart amputation, involves surgically removing a part of the foot at the midtarsal joint. This procedure is generally performed to address serious foot conditions or injuries that cannot be treated through less invasive methods.

Purpose

The primary purpose of this procedure is to remove diseased, nonviable, or damaged tissues, which can prevent spread of infection or alleviate severe pain. The goals of the surgery include improving the patient's quality of life, enabling the use of prosthetics, and facilitating functional mobility.

Indications

• Severe trauma or injury to the foot
• Gangrene or necrosis due to poor circulation
• Infections unresponsive to antibiotics
• Diabetic foot complications
• Tumors in the foot region
• Unmanageable pain not relieved by other treatments

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustments to medication, particularly blood thinners
• Pre-surgical assessments including blood tests, imaging studies (X-rays, MRI, or CT scans), and cardiovascular evaluations

Procedure Description

1. The patient is given regional or general anesthesia.
2. The surgical area is sterilized and prepped.
3. An incision is made at the midtarsal joint, located between the tarsal bones and the metatarsal bones.
4. The surgeon carefully dissects and removes the portion of the foot while preserving as much healthy tissue as possible.
5. Blood vessels are sealed, and nerves are treated to minimize post-operative pain.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Tools/Equipment: Surgical scalpels, forceps, medical saw, sutures, cauterizing tools

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity and any unforeseen issues.

Setting

The surgery is performed in a hospital or surgical center equipped with an operating room.

Personnel

• Orthopedic or vascular surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Pain or phantom limb sensation
• Delayed wound healing
• Need for further amputation

Benefits

• Elimination of nonviable tissue reduces infection risk
• Pain relief
• Improved mobility with prosthetics
• Enhanced overall quality of life

Recovery

• Initial hospital stay of several days
• Wound care instructions and possibly a wound VAC (vacuum-assisted closure) device
• Physical therapy for mobility training with a prosthetic
• Follow-up appointments to monitor healing
• Restrictions on weight-bearing activities for several weeks

Alternatives

• Debridement or partial foot amputation
• Revascularization procedures for improving blood flow
• Advanced wound care and infection control methods
• Orthotic devices to support foot function

Pros and cons of alternatives include less invasive options but might not be sufficient in severe cases, whereas more extensive procedures provide definitive resolutions but come with higher risks.

Patient Experience

During the procedure, the patient will be under anesthesia and should feel no pain. Post-operatively, they may experience pain manageable with medications. Physical sensations might include soreness and swelling. Long-term, patients will adapt to life with a prosthetic limb and feel more comfortable and mobile as they recover. Pain management and support from a healthcare team will be provided to ensure the best possible recovery experience.