Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia
Background: Above-knee amputation (AKA) is not suitable for certain ultra-high-risk patients owing to its surgical invasiveness and accompanying anesthesia. We developed a simple technique for AKA under nerve block and local anesthesia, which is quick and associated with little blood loss compared w...
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Elsevier
2025-08-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468428725001224 |
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| author | Marin Mimura, MD Yu Kagaya, MD, PhD Hikaru Kono, MD Toshiki Furukawa, MD Tetsu Kojima, MD Fumio Onishi, MD, PhD |
| author_facet | Marin Mimura, MD Yu Kagaya, MD, PhD Hikaru Kono, MD Toshiki Furukawa, MD Tetsu Kojima, MD Fumio Onishi, MD, PhD |
| author_sort | Marin Mimura, MD |
| collection | DOAJ |
| description | Background: Above-knee amputation (AKA) is not suitable for certain ultra-high-risk patients owing to its surgical invasiveness and accompanying anesthesia. We developed a simple technique for AKA under nerve block and local anesthesia, which is quick and associated with little blood loss compared with conventional AKA. We report our experience with this procedure. Methods: The affected extremity was provided analgesia with a combination of nerve block (femoral and sciatic nerve block) and local anesthesia of a low concentration. Our amputation method comprises two key stages: an initial knee disarticulation and a subsequent supracondylar osteotomy. The muscles were cut at the tendon, the artery was ligated at the popliteal fossa, and subperiosteal dissection for amputation of the femoral condyle was minimized. The wound was closed roughly without osteomyodesis. We included 12 consecutive patients on whom the procedure was performed (7 with chronic limb-threatening ischemia and 5 with acute limb ischemia) while they were taking anticoagulant or antiplatelet drugs. All the patients had an American Society of Anesthesiologists physical status of class III or higher (class III: severe systemic disease with substantive functional limitations [n = 6]; class IV: severe systemic disease that is a constant threat to life [n = 6]). Results: All the surgeries were successfully completed. The mean ± standard deviation operation time was 36.0 ± 8.4 minutes, and blood loss was 52.1 ± 37.5 mL. Minor perioperative wound complications occurred in only two cases. The patients' activities of daily living after the operation were the same as before surgery in each case. Conclusions: The presented method is a potential treatment for severe lower limb necrosis in ultra-high-risk patients for whom traditional AKA is impossible owing to intolerance for general anesthesia and invasive surgery. However, the long-term results are as yet unknown. |
| format | Article |
| id | doaj-art-00f5e700e40c44f4859342b43fde8f9c |
| institution | Matheson Library |
| issn | 2468-4287 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj-art-00f5e700e40c44f4859342b43fde8f9c2025-07-27T04:56:10ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872025-08-01114101840Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesiaMarin Mimura, MD0Yu Kagaya, MD, PhD1Hikaru Kono, MD2Toshiki Furukawa, MD3Tetsu Kojima, MD4Fumio Onishi, MD, PhD5Department of Plastic, Reconstructive and Aesthetic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JapanDepartment of Plastic, Reconstructive and Aesthetic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan; Department of Plastic and Reconstructive Surgery, Horinouchi Hospital, Saitama, Japan; Correspondence: Yu Kagaya, MD, PhD, Department of Plastic, Reconstructive and Aesthetic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda Kawagoe, Saitama 350-8550, JapanDepartment of Plastic, Reconstructive and Aesthetic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JapanDepartment of Plastic and Reconstructive Surgery, Horinouchi Hospital, Saitama, JapanDepartment of General Surgery, Horinouchi Hospital, Saitama, JapanDepartment of Plastic, Reconstructive and Aesthetic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, JapanBackground: Above-knee amputation (AKA) is not suitable for certain ultra-high-risk patients owing to its surgical invasiveness and accompanying anesthesia. We developed a simple technique for AKA under nerve block and local anesthesia, which is quick and associated with little blood loss compared with conventional AKA. We report our experience with this procedure. Methods: The affected extremity was provided analgesia with a combination of nerve block (femoral and sciatic nerve block) and local anesthesia of a low concentration. Our amputation method comprises two key stages: an initial knee disarticulation and a subsequent supracondylar osteotomy. The muscles were cut at the tendon, the artery was ligated at the popliteal fossa, and subperiosteal dissection for amputation of the femoral condyle was minimized. The wound was closed roughly without osteomyodesis. We included 12 consecutive patients on whom the procedure was performed (7 with chronic limb-threatening ischemia and 5 with acute limb ischemia) while they were taking anticoagulant or antiplatelet drugs. All the patients had an American Society of Anesthesiologists physical status of class III or higher (class III: severe systemic disease with substantive functional limitations [n = 6]; class IV: severe systemic disease that is a constant threat to life [n = 6]). Results: All the surgeries were successfully completed. The mean ± standard deviation operation time was 36.0 ± 8.4 minutes, and blood loss was 52.1 ± 37.5 mL. Minor perioperative wound complications occurred in only two cases. The patients' activities of daily living after the operation were the same as before surgery in each case. Conclusions: The presented method is a potential treatment for severe lower limb necrosis in ultra-high-risk patients for whom traditional AKA is impossible owing to intolerance for general anesthesia and invasive surgery. However, the long-term results are as yet unknown.http://www.sciencedirect.com/science/article/pii/S2468428725001224Above-knee amputationThrough-knee amputationChronic limb-threatening ischemiaAcute limb ischemiaNerve block |
| spellingShingle | Marin Mimura, MD Yu Kagaya, MD, PhD Hikaru Kono, MD Toshiki Furukawa, MD Tetsu Kojima, MD Fumio Onishi, MD, PhD Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia Journal of Vascular Surgery Cases and Innovative Techniques Above-knee amputation Through-knee amputation Chronic limb-threatening ischemia Acute limb ischemia Nerve block |
| title | Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia |
| title_full | Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia |
| title_fullStr | Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia |
| title_full_unstemmed | Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia |
| title_short | Simplified above-knee amputation with short operation time and minimal blood loss for ultra-high-risk patients under nerve block and local anesthesia |
| title_sort | simplified above knee amputation with short operation time and minimal blood loss for ultra high risk patients under nerve block and local anesthesia |
| topic | Above-knee amputation Through-knee amputation Chronic limb-threatening ischemia Acute limb ischemia Nerve block |
| url | http://www.sciencedirect.com/science/article/pii/S2468428725001224 |
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