Perioperative management - Right knee disarticulation for Fontaine stage IV peripheral arterial disease (PAD).

• PAOD Fontaine stage IV of the foot and distal lower leg
• where the vascular periphery cannot be reconstructed, below-knee amputation must be ruled out or the options for more distal amputation are exhausted
• the profunda femoris artery (PFA) should preferably be patent, otherwise healing of the stump is jeopardised; if necessary, prior reconstruction of the PFA

Classification of PAOD according to the Fontaine stages and Rutherford categories

• general inoperability
• amputation can be performed more distally
• necrosis up to one handbreadth inferior to the knee joint
• massive infection of the lymphatic vessels in the lower leg

DSA

• preoperative DSA must be available to demonstrate local inoperability with regard to revascularisation
• no major amputation without angiography in PAOD
• possibly transcutaneous pO2 measurement to determine the amputation level

Laboratory panels

• complete blood count
• electrolytes
• kidney function parameters
• coagulation
• blood group

Resting ECG

Chest X-ray

• perioperative antibiotic prophylaxis
• 2 units of packed red blood cells available

• allergy/intolerance, e.g., to latex, drugs; acute cardiovascular response; intensive care measures; possibly permanent damage (e.g., organ failure, brain damage, paralysis)
• secondary bleeding, haematoma, possibly reoperation
• transfusion of allogeneic blood or blood components: risk of contracting hepatitis, HIV
• skin, tissue and nerve damage due to positioning, measures accompanying the procedure (injections, disinfection, current); possibly long-term effects (pain, paralysis, inflammation, necrosis)
• impaired wound healing, infection, osteitis, fistula formation; possibly surgical measures, reamputation, sepsis
• thrombosis/embolism
• keloids, neuroma, phantom pain
• functional impairment of the residual limb, the contralateral limb or the spine due to incorrect and excessive weight bearing