In his lecture on Forefoot Amputations, Michael Cohen, DPM describes the scene during Civil War, when amputation procedures were done without anesthesia, using wood handled, non-sterile instruments.

Times have changed quite dramatically, yet amputation surgery still represents a circumstance in which the foot and ankle specialist is forced to deal with life and death issues, just like the battlefield surgeons of old. In fact, 50% of the population of patients who undergo non-traumatic related amputations die 36 months after surgery. 50% of amputation patients undergo amputation surgery on the contralateral limb with 2 years. Fortunately, great strides have been made in the specialty areas of vascular surgery and invasive cardiology. Bypass procedures into the foot, into one of the trifurcation vessels, angioplasty and stenting provide improvement in the ischemia and assist in wound healing. Unfortunately, these come with a "ticking time clock complete with alarm". In his 2 lectures on modern amputation techniques, Dr. Cohen discusses factors that are critical for healing of wounds and amputation sites, such as serum albumin, total lymphocyte count and ABI's/TCPO2. Of course, a thorough vascular assessment is essential. Is the skin shiny? What about hair growth? Do ischemic lesions exist? Dr. Cohen reviews invasive and non-invasive evaluations. Case studies that discuss the importance of adequate debridement and proper antimicrobial therapy, both intra op and post operatively are presented. An understanding of how infections track along tendon sheaths and the anatomical compartments of the foot is vital. The involvement of a good prosthetist greatly enhances the likelihood of success. Settle back and listen to Michael Cohen's definitive lecture on Rearfoot amputations.