Pirogoff amputation for forefoot severe chronic deep infection in patients with diabetis mellitus: interest of a fixation by Ilizarov system

Surgical results and functional outcome of a derived Pirogoff amputationprocedure using external fixation with Ilizarov techniquewere studied retrospectively in 12 patients with severe diabetesmellitus who had needed amputation for forefoot severe chronicdeep infection. Follow-up was over one year for all patients. Allpatients had severe peripheral vascular disease. The amputation wascarried out as described by Pirogoff, but the calcaneous was boundon the end of the tibia with an external Ilizarov system. The patientswere allowed to walk over the stump with full weight bearing immediately.Fusion of the arthrodesis was achieved in all 12 caseswith an average of 2 months (45 days to 5 months) and we did notobserve any case of stump dislocation. The stump had a good trophicityin all cases and there was no recurrence of infection. Afterremoval of the Ilizarov system, patients were able to wear shoeswith adequate prostheses and to deambulate successfully. The Pirogoffamputation has the advantage of creating a strong weightbearingstump that is the same length as the patient’s normal leg.But stump dislocation is an important complication of this technique.To avoid this problem, the use of splinting of the stump in thepostoperative period is mandatory but it prolongs the patients’ postoperativerehabilitation. The Ilizarov system is solid enough toallow immediate postoperative full weight bearing and improves thebone fusion by micromobility. It makes the care of an eventualwound easier.