When is guillotine ankle amputation indicated?

Updated: Nov 18, 2019
  • Author: Vinod K Panchbhavi, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Answer

A guillotine ankle amputation is indicated in the presence of severe infection or necrosis in the midfoot or hindfoot, such as a wet gas gangrene or fulminant osteomyelitis in the hindfoot, and similar conditions that preclude salvage of a functional foot. In such scenarios, patients are frequently febrile and have bacteremia.

Under these circumstances, a primary definitive amputation carries a risk for wound infection and a higher-level amputation. The initial guillotine amputation helps control the infection, eliminate the bacteremia, and provide a safer wound environment for a definitive amputation at a later date. Thus, it is preferred as a first stage to control infection, followed by a definitive below-the-knee amputation.

The release of toxins into the systemic circulation from fulminant infections in the foot and the presence of comorbidities such as diabetes mellitus can cause septic shock and compromise the ability of patients to tolerate anesthesia or prolonged surgery. In such situations, a guillotine-type amputation, which can be rapidly performed, allows removal of the diseased foot—a necessary step to eliminate systemic toxins and save the patient's life.

Although the two-stage amputation technique entails an additional operation, guillotine amputation at the ankle level is recommended as a first stage to deal with nonsalvageable infections such as wet gangrene in the midfoot or hindfoot because it allows subsequent wound closure with a reduced chance of wound infection. [1]  (See Outcomes.)


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