PIROGOVA AMPUTATION

From Big Medical Encyclopedia

PIROGOVA AMPUTATION ( N. I. Pirogov , the domestic surgeon and the anatomist, 1810 — 1881) — osteoplastic amputation of a shin at the level of a distal epiphysis of bones with movement of them opit the kept hillock of a calcaneus and soft tissues covering it for creation of a basic stump. This operation is for the first time executed by N. I. Pirogov in 1852 and described by it in 1854. P.'s originality and. is in what is its cornerstone bone plastics (see) with movement of a transplant on the feeding leg. Besides, the stump across Pirogov has the natural bone basis adapted for execution of loading. It favourably distinguishes it from stumps of a shin after amputation at other levels.

Item and. it is shown in cases when patol, the changes forcing to removal of foot (mechanical or thermal damage, a vicious and not basic stump of front department of foot, osteomyelitis, tuberculosis, a new growth, gangrene) do not extend to a distal epiphysis of bones of a shin and calcaneal area.

Fig. 1. The scheme of amputation across Pirogov: at the left — lines of opil of bones of a shin and a calcaneus; on the right above — a postoperative stump.

Item and. carry out under anesthetic, conduction or local anesthesia, carry out a stremyaobrazny section of skin on side surfaces of the lower third of a shin at the level of anklebones with transition to average department of foot; after mobilization of skin rags both bones of a shin saw immediately above anklebones and carry out a cross osteotomy of a calcaneus (fig. 1). After removal of foot the remained back department of a calcaneus together with a skin rag is moved up and densely compared with a surface of an opil of bones of a shin, fixing seams on soft tissues. On the operating table apply a circular plaster bandage to the lower third of a hip, it is good otmodelirovav it on contours of a stump. The bandage remains within 2 — 2,5 months (before full consolidation of bone fragments). Load of the operated extremity in gypsum is allowed not earlier than 1,5 months after operation.

P.'s lack and. the tension of a calcaneal (akhillov) sinew arising during the movement of a calcaneal hillock, and also partial shift of a calcaneal fragment of a kzada or knutra owing to insufficient fixing of bone fragments is a plaster bandage.

Fig. 2. The scheme of amputation across Pirogov in Günter's modification: lines of an opil of bones pass in the slanting direction from top to down; on the right above — a postoperative stump.
Fig. 3. The scheme of amputation across Pirogov in Lefor and Esmarkh's modification: the calcaneus is sawn round in the horizontal plane; on the right above — a postoperative stump.
Fig. 4. Scheme of connection of an express prosthesis with Ilizarov's device: 1 — rings of the device of Ilizarov, 2 — a prosthesis of foot, 3 — a fragment of a calcaneus.

Purpose of various modifications of P. and. — prevention of shift of a calcaneal fragment in the postoperative period and increase in support-nosti of a stump. So, J. Gunther made for reduction of a tilt angle of a calcaneus opit it in the slanting direction (fig. 2), and Lefor and Esmarkh (L. Page of Le Fort, S. Esmarch) — in horizontal (fig. 3). With the same purpose peculiar bone locks were created, fixed a calcaneal fragment bone or metal nails, and also sinews of the truncated muscles. The best results, including reduction of terms of rehabilitation of patients, are reached by method Kohn-drashina, Sanina and Yusupova. Osteoplastic operation on this method is performed typically across Pirogov and comes to an end with a compression osteosynthesis by means of Ilizarov's (fig. 4) device. On the operating table to the lower ring of the device fix a medical and training prosthesis (see. Distraktsionno-kompressionnye devices ). The plaster bandage is not applied that provides good access to an operational wound. This method excludes the secondary shift of a fragment of a calcaneus and allows after amputation to carry out LFK, massage, a training of an opornost of a stump and physiotherapeutic procedures to early terms. The patient starts walking on a medical and training prosthesis in 1 — 3 day after operation, and in 18 — 21 days after operation passes to a constant prosthesis or orthopedic footwear with a supplementary shoe. These features of a method allow to receive good functional results of prosthetics, to considerably reduce terms of stay of patients in clinic. After P. and. and express prosthetics patients are returned to socially useful work in 1,5 — 2 months

See also Amputation .



Bibliography: Kondrashin H. And., Sanin V. G. and Yusupov V. K. An amputating stump of a shin across Pirogov and prosthetics of disabled people, Ortop, and travmat., No. 12, page 1, 1975; they, our method of express prosthetics after amputation of a shin across Pirogov, in the same place, No. 8, page 13, 1976; Pies N. I. Osteoplastic lengthening of bones of a shin at enucleation of foot, Voyen. - medical zhurn., p. 63, No. 2, otd. 2, page 83, 1854; Tsakhayev N. Ts. Modifications of osteoplastic amputation on N. I. Pirogov's way, in book: Vopr, prosthetics, under the editorship of M. V. Strukov, century 6, page 74, L., 1958.


N. I. Koidrashin.

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