{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T08:54:19Z","timestamp":1793350459024,"version":"4.5.0"},"reference-count":33,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,6,2]],"date-time":"2024-06-02T00:00:00Z","timestamp":1717286400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Specialist"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>A transtibial amputation is the traditional primary staged amputation for source control in the setting of non-salvageable lower extremity infection, trauma, or avascularity prior to progression to proximal amputation. The primary aim of the study is to compare preoperative risk factors and postoperative outcomes between patients who underwent transtibial amputation versus ankle disarticulation in staged amputations. A retrospective review of 152 patients that underwent staged below the knee amputation were compared between those that primarily underwent transtibial amputation (N = 70) versus ankle disarticulation (N = 82). The mean follow-up for all 152 patients was 2.1 years (range = 0.04-7.9 years). The odds of incisional healing were 3.2 times higher for patients with guillotine amputation compared to patients with ankle disarticulation (odds ratio [OR] = 3.2, 95% confidence interval [CI] = 1.437-7.057). The odds of postoperative infection is 7.4 times higher with ankle disarticulation compared to patients with guillotine amputation (OR = 7.345, 95% CI = 1.505-35.834). There were improved outcomes in patients that underwent staged below the knee amputation with primarily guillotine transtibial amputation compared to primarily ankle disarticulation. Ankle disarticulation should be reserved for more distal infections, to allow for adequate infectious control, in the aims of decreasing postoperative infection and improving incisional healing rates.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Levels of Evidence:<\/jats:bold>\n                    <jats:italic toggle=\"yes\">3, Retrospective study<\/jats:italic>\n                  <\/jats:p>","DOI":"10.1177\/19386400241253880","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T02:51:21Z","timestamp":1717383081000},"page":"254-261","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes in Drainage Ankle Disarticulation vs Guillotine Transtibial Amputation in the Staged Approach to Below-Knee Amputation"],"prefix":"10.1177","volume":"19","author":[{"given":"Alissa M.","family":"Mayer","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7694-488X","authenticated-orcid":false,"given":"Nicole K.","family":"Cates","sequence":"additional","affiliation":[{"name":"Fellowship Trained Foot and Ankle Surgeon, Hand &amp; Microsurgery Medical Group, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Tefera","sequence":"additional","affiliation":[{"name":"Department of Biostatistician and Biomedical Informatics, MedStar Health Research Institute, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin K.","family":"Ragothaman","sequence":"additional","affiliation":[{"name":"Fellowship Trained Foot and Ankle Surgeon, Foot and Ankle Associates, Cupertino, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen K.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Attinger","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,2]]},"reference":[{"key":"e_1_3_3_2_2","volume-title":"Estimates of Diabetes and Its Burden in the United States. 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Ostomy Wound Manage. 2004;50(6):50-60.","journal-title":"Ostomy Wound Manage"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000225459.93750.29"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.10.083."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800730527"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(88)90106-1"},{"issue":"261","key":"e_1_3_3_10_2","first-page":"251","article-title":"Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections","volume":"1990","author":"Kernek CB","unstructured":"Kernek CB, Rozzi WB. Simplified two-stage below-knee amputation for unsalvageable diabetic foot infections. 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A reliable surgical approach for the two-staged amputation in the unsalvageable limb and the life threatening acute progressive diabetic foot infections: tibiotalar disarticulation with vertical crural incisions and secondary transtibial amputation. 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