Amputation Revision Surgery - Refining the surgical approach. Ten years of experience and 250 cases, impressions, outcomes, and thoughts for the future.

Abstract Introduction: The decision for revision amputation surgery requires a multi-disciplinary approach and the evidence on outcome data available in the current literature is limited. The aim of this observational, retrospective study was to investigate in patients undergoing stump revision, whether factors such as pathology and reason for the revision surgery affect surgical ‘success’ rates as primary outcomes. Secondary outcomes of interest include rehabilitation outcomes and complication rates. Methods: From December 2008 to November 2018, 250 amputation revision procedures were performed at our centre. Surgical and rehabilitation outcomes and indication for revision surgery were measured for each patient. Results: There was an overall surgical success rate of 81% and an overall rehabilitation success rate of 63%, with variable outcomes related to the indication for surgery. Revisions for bony pathology had excellent results from a surgical perspective (100%) and good results from a rehabilitation perspective (71%). Revisions for soft tissue pathology and neuroma had satisfactory results from a surgical perspective (81% and 74% respectively) and rehabilitation perspective (56% and 71% respectively). Surgical success rates for those undergoing revision surgery due to non-neuroma pain were poor. Conclusions: We found that revision surgery for defined anatomical abnormalities, such as bone pathology or neuromata are associated with good outcomes. Surgical techniques, specifically related to the management of neuromas are continuing to develop, with promising results from the application of targeted muscle reinnervation (TMR) in the treatment of neuromata. The primary amputation surgeon should exercise caution when considering compromising bone length for soft tissue or skin coverage, as revision surgery can address the excision of skin graft or refashioning of the soft tissue envelope at a later stage. Careful patient selection is key to ensure we advocate offering our patients the right operation at the right time, for the right pathology.