Chopart amputation

Chopart amputation

1. CHOPART AMPUTATION DR.PONNILAVAN

2. Chopart Amputation  Francis Chopart first described disarticulation thru midtarsal joint. Chopart amputation removes the forefoot and midfoot, saving talus and calcaneus. Unstable amputation , noting that most of the tendons which act around the ankle joint have lost their insertion into foot and the heel remains unstable;

3.  has a pronounced tendency to go into equinus and must usually be fitted with a prosthesis that extends upto the patellar tendon level  if the ankle joint is in a neutral position and good ankle motion is present, AFO derivatives or boot type prostheses may be required;

4. Chopart Amputation:Technique To avoid contamination, begin by making a posteromedial incision and then perform a tenotomy of the Achilles tendon. Excise 2 cm of tendon, and attempt to preserve the sheath of the Achilles tendon. Handle the soft tissue with care.

5. Chopart Amputation Mark the skin incision preoperatively, creating a “ fishmouth ” flap on the plantar surface. Begin the incision at the transtarsal joints medially and laterally. Extend the flaps in a dorsal and plantar direction, creating adequate skin flaps for coverage

6. Chopart Amputation

7. Chopart Amputation Identify the anterior tibial and extensor hallucis longus tendons resect them distally, and prepare them for transfer

8. Chopart Amputation Identify the transverse tarsal (calcaneocuboid and talonavicular) joints, and disarticulate them by releasing the dorsal and plantar ligaments

9. Transfer the anterior tibial tendon to the lateral aspect of the neck of the talus, using a bone tunnel with a biotenodesis screw or by creating a trough in the talus and using a suture anchor or staple to secure fixation

10. Close the wound by approximating the fascial layers plantarly and dorsally and then the skin in a tension-free manner. Place a drain as needed after hemostasis has been obtained and the wound copiously irrigated

11. Post op The dorsiflexion rigid dressing is changed intermittently to check the wound. Sutures are kept in place for 4 to 6 weeks to allow for adequate healing. The splint must be worn for 6 to 8 weeks to prevent equinus contracture of the hindfoot. The patient will need an ankle-foot orthosis in a rocker-sole shoe (e.g., running shoe) for ambulation

12. complication Progressive equinovarus deformity   - transfer of the anterior tibial tendon has an insufficient moment arm to prevent this - initial release of the tendo achilles may reduce this problem; - with all amputations of the foot, there will be some loss of normal arch of the foot

13. The modified Chopart's amputation A modified Chopart's amputation has been designed to overcome the complications of the traditional Chopart's amputation of plantar flexion and skin breakdown over the anterior talus and calcaneus. 

14. Modifications Contouring of the talus and calcaneus; Transfer of the anterior and posterior tibialis tendons and the extensor communis and hallucis to the neck of the talus and sustentaculum tali ; Anterior advancement of the plantar flap; and Lengthening of the tendo Achillis . 

15. SOURCE CAMPBELL ROCKWOOD

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