As Bernard Shaw observed: "If I re...

As Bernard Shaw observed: "If I refuse to allow my leg to be amputated, it's mortification and my death may substantiate that I was wrong; unless if I let the leg walk nobody can ever prove that it would not have mortified had I been obstinate. Operation is, therefore, the safe side for the surgeon "

on the other hand what operation? The vast majority of amputations are performed for vascular disease. Arterial reconstruction--beside being a more viable solution to the puzzle of critical leg ischemia--even expenses less than a major amputation when all factors are considered. Post-operative duplex surveillance is also shown to be cost-effective.

Other parts of Bernard Shaw's doctors' dilemma are well dissected here from 77 international experts, including the natural history of a critically ischemic patient with and without his leg and when and by what means should we assess reconstructability (including bi-planar arteriography, value of pedal arch patency, part of magnetic resonance spectroscopy, what can transcutaneous oxygen measurements enumerate us, etc).

Regarding operative techniques for limb salvage in chronic critical ischemia, to a great degree of the discussion quickly masters down to nitty grittys like when is profunda repair essential? What is the character of short infra-geniculate vein grafts? in what way do we detect and treat fibrous vein grafts strictures? What is the best way to disrupt valves for in situ grafts? Besides everyday operative interventions for acute ischemia, the case for initial lysis and percutaneous concrete removal is also introduced.

The team approach to amputation is well outlined, as is a refinement of the below-knee amputation technique called the "skew flap" orderly disposition One advantage of this modern method is that the shape of the skew stub allows limb fitting at an earlier stage than that seen in the protracted posterior flap method. All those interested in a multi-disciplinary approach to limb salvage and amputation of vascular disease will take delight in this text.

Alan T: Marty, MD FCCP Evansville, Indiana

COPYRIGHT 1989 American community of Chest Physicians

COPYRIGHT 2004 Gale Group