Ilizarov external frame technique for pirogoff amputations with ankle disarticulation and tibiocalcaneal fusion

Background: The high rates of wound failure, persisting infection, and nonunion of the tibiocalcaneal arthrodesis are the main reasons why the Pirogoff ankle disarticulation is rarely used for limb salvage. Use of the Ilizarov external frame has increased our fusion rate. The purpose of this study was to review our experience with the use of the Ilizarov external frame as a technique for Pirogoff amputations with ankle disarticulation and tibiocalcaneal fusion.

Methods: Twenty-four patients (median age, 57.4 years; range, 29-76 years) underwent a Pirogoff amputation with Ilizarov external frame use between January 2004 and June 2011. The most common indications were gangrene with uncontrollable infection due to Charcot arthropathy or chronic osteomyelitis. Four patients had sustained crush injuries of the foot. All patients were clinically and radiographically followed for a minimum of 12 months. Additionally, 15 patients were evaluated using the Taniguchi rating scale for Pirogoff amputations after a mean follow-up of 44.9 months (range, 12-86 months).

Results: In 21 patients (87.5%), a well-healed Pirogoff stump was achieved after a mean external fixation time of 18.1 weeks (range, 12.7-26.6 weeks). Impaired vascular perfusion was found to be the limiting factor for successful wound healing and an overall successful Pirogoff amputation. According to the Taniguchi scale, 67% of the patients achieved good or excellent functional results. Fair (27%) and poor (6%) results were observed only in the diabetic patients.

Conclusion: Using the Ilizarov external frame allowed safe fixation and a high success rate, even in neuropathic feet. The frame allowed for immediate weight-bearing and soft tissue control; however, frame-associated complications were common and could result in revision surgery.

Level of evidence: Level IV, case series.