Warren G
The Leprosy Mission International, Windmill Road, Brentford, London, U.K..
Oper Orthop Traumatol. 1997 Mar;9(1):49-58. doi: 10.1007/s00064-006-0008-6.
Lesions limited to the forefoot when reconstruction of the forefoot is impossible. In situations where due to the unavailability of protheses a forefoot amputation has to be done.
Absolute: Badly scarred or destroyed calcaneum and/or heel pad. Osteomyelitis of lower tibia or calcaneum. Malignancy of the heel area. Relative: Inadequate circulation of the heel area. Uncontrolled diabetes mellitus.
Forefoot amputation with arthrodesis between tibia and os calcis. Specially applicable in patients with neuropathy because this simple procedure leaves a stable stump. Prosthetic fitting not mandatory. Negligible shortening of limb.
Bed rest, elevation of limb, and protective splinting for 3 postoperative days. Non weight bearing on crutches for the next 2 weeks, then well fitted contact cast with Böhler iron for walking. Application of prosthesis not before bony consolidation.
Infections. Treat very intensively.
Fifty modified Pirogoff procedures were done over 30 years, mostly for leprosy or malignancy. Long-term follow-up available of 16 patients who suffered from leprosy (see Figure 11).
当无法进行前足重建时，适用于仅限于前足的病变。在因无法获得假体而必须进行前足截肢的情况下。
绝对禁忌症：跟骨和/或足跟垫严重瘢痕化或破坏。胫骨或跟骨骨髓炎。足跟区域恶性肿瘤。相对禁忌症：足跟区域血液循环不足。未控制的糖尿病。
经胫骨和跟骨之间关节固定术的前足截肢术。特别适用于患有神经病变的患者，因为这个简单的手术会留下一个稳定的残端。不强制安装假肢。肢体缩短可忽略不计。
术后卧床休息、抬高肢体并进行保护性夹板固定3天。接下来的2周使用拐杖不负重，然后使用带Böhler铁的合适接触石膏行走。在骨愈合之前不安装假肢。
感染。需积极治疗。
30年间共进行了50例改良Pirogoff手术，主要用于治疗麻风病或恶性肿瘤。对16例患有麻风病的患者进行了长期随访（见图11）。
