Pirogow’s Amputation: A Modification of the Operation Method

Introduction. Pirogow’s amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score). Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used. Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow’s amputation) only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility. Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference. 1. Introduction In his original article from 1854, Nikolai Iwanowitsch Pirogow reported on hundreds of lower limb amputations he carried out during the Crimean war [1] (Figure 1). The Crimean war was fought between Imperial Russia on one side and an alliance of France, the United Kingdom, the Kingdom of Sardinia, and the Ottoman Empire on the other. The goal of the anti-Russian alliance was to break the Russian position of power around the Black Sea and to put a halt to Russian expansion into the Balkan territory of the Ottoman Empire. The war broke out in 1853 on the Crimean peninsula and ended in 1856 with Russia’s loss. The battles fought were not the only cause of the numerous lives lost during the war. Medical care during the war was incredibly substandard, causing the British nurse Florence Nightingale to construct and reorganize numerous military hospitals and care stations. The Crimean war saw an increased use of