Common levels of amputation

1. What are three unsatisfactory levels for leg amputation?
2. What are pros and cons of partial foot vs. toe amputations?
3. What are the advantages of transmetatarsal amputation?
*4. What is the difference betwen a Lisfranc and Chopart amputation? What is a common complication of both?
*5. What is a Syme's amputation and what are the pros/cons?

Answers:
1. Distal 2/5 of tibia (below gastrocsoleus) due to skin breakdown, very short below knee amputation due to loss of knee extension resulting in flexion contractures, and very high above-knee amputation due to flexion/abduction contractures.
2. Pros of toe amputation include improved mechanical advantage and better gait pattern. Cons include possible progression of the vascular problems in a compromised patient.
3. Preserves attachment of DFs and PFs, which gives patient good mechanical advantage.
4. A Lisfranc amputation is at the tarso-metatarsal junction. A Chopart amputation is distal to the talus and calcaneus bones. In both amputations, the foot develops a significant equinus deformity, resulting in skin breakdown. This can be prevented by DF tendon implantation with Achilles lengthening.
5. Syme's amputation is an ankle disarticulation with attachment of the distal heel pad to the end of the tibia. Pros include maintenance of limb length, excellent wt bearing, good prosthetic tolerance. Cons include poor cosmesis of prosthetic.