Chopart amputation

Chopart amputation

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  CHOPART AMPUTATION DR.PONNILAVAN
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  Chopart Amputation • FrancisChopart 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;
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  • has apronounced 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;
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  Chopart Amputation:Technique To avoidcontamination, 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.
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  Chopart Amputation • Markthe 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
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  Chopart Amputation
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  Chopart Amputation • Identifythe anterior tibial and extensor hallucis longus tendons resect them distally, and prepare them for transfer
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  Chopart Amputation • Identifythe transverse tarsal (calcaneocuboid and talonavicular) joints, and disarticulate them by releasing the dorsal and plantar ligaments
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  • Transfer theanterior 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
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  • Close thewound 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
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  Post op • Thedorsiflexion 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
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  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
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  The modified Chopart'samputation 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.
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  Modifications • Contouring ofthe 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.
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  SOURCE • CAMPBELL • ROCKWOOD
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