{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T19:05:13Z","timestamp":1792523113323,"version":"4.5.0"},"reference-count":13,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The optimal management of major stump complications (operative infection or dehiscence) following below-knee-amputation (BKA) is unknown. We evaluated a novel operative strategy to aggressively treat major stump complications hypothesizing it would improve our rate of BKA salvage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of patients requiring operative intervention for BKA stump complications between 2015 and 2021. A novel strategy employing staged operative debridement for source control, negative pressure wound therapy, and reformalization was compared to standard care (less structured operative source control or above knee amputation).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>32 patients were studied, 29 of which were male (90.6%) with an average age of 56.1 \u00b1 9.6\u00a0y. 30 (93.8%) had diabetes and 11 (34.4%) peripheral arterial disease (PAD). The novel strategy was used in 13 patients and 19 had standard care. Novel strategy patients had higher BKA salvage rates, 100% vs 73.7% ( P = .064), and postoperative ambulatory status, 84.6% vs 57.9% ( P = .141). Importantly, none of the patients undergoing the novel therapy had PAD, while all progressing to above-knee amputation (AKA) did. To better assess the efficacy of the novel technique, patients progressing to AKA were excluded. Patients undergoing novel therapy who had their BKA level salvaged (n = 13) were compared to usual care (n = 14). The novel therapy\u2019s time to prosthetic referral was 72.8 \u00b1 53.7\u00a0days vs 247 \u00b1 121.6\u00a0days ( P &lt; .001), but they did undergo more operations (4.3 \u00b1 2.0 vs 1.9 \u00b1 1.1, P &lt; .001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Utilization of a novel operative strategy for BKA stump complications is effective in salvaging BKAs, particularly for patients without PAD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348231175504","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T11:47:41Z","timestamp":1684324061000},"page":"4055-4060","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["A Novel Strategy to Manage Below-Knee-Amputation (BKA) Stump Complications for Early Wound Healing and BKA Salvage"],"prefix":"10.1177","volume":"89","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7233-1306","authenticated-orcid":false,"given":"Naveen","family":"Balan","sequence":"first","affiliation":[{"name":"Harbor-UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Qi","sequence":"additional","affiliation":[{"name":"Harbor-UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Keeley","sequence":"additional","affiliation":[{"name":"Harbor-UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Neville","sequence":"additional","affiliation":[{"name":"Harbor-UCLA Medical Center, Torrance, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"bibr1-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000967"},{"key":"bibr2-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/J.EJVS.2005.02.014"},{"key":"bibr3-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2003.07.027"},{"key":"bibr4-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/J.JVS.2017.08.061"},{"key":"bibr5-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2014.05.050"},{"key":"bibr6-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1001\/ARCHSURG.139.4.395"},{"key":"bibr7-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1007\/S00268-008-9500-5"},{"key":"bibr8-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1097\/CORR.0000000000001455"},{"key":"bibr9-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/J.JVS.2017.10.051"},{"key":"bibr10-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpm.2009.08.002"},{"key":"bibr11-00031348231175504","first-page":"227","volume":"92","author":"Jeffery K","year":"2018","journal-title":"Orthopedic Proceedings"},{"key":"bibr12-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1177\/0309364611430535"},{"key":"bibr13-00031348231175504","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2020.07.038"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348231175504","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348231175504","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348231175504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:01Z","timestamp":1777379881000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.sagepub.com\/doi\/10.1177\/00031348231175504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,17]]},"references-count":13,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1177\/00031348231175504"],"URL":"https:\/\/doi.org\/10.1177\/00031348231175504","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,17]]}}}