Standard and non-standard LL amputations, by Keith Jones.

Amputations, by Keith Jones

Good talk.

Gave plenty of historial background

Mentioned Burgess

Then the European modification of the long posterior flap - Bruckner

Talked about Kingsley Robinson who sadly died in 1991, the originator of the skew flap

Emphasised that in the KR skew it was only the skin flap that is skewed; not the muscle

Mentioned another BKA reconstruction technique which DOES skew the muscle flap; that’s a different one.

Then spoke of something called the Ertl. I haven’t encountered that before.

Proceeded to talk about minor amputations.

Helpful point about the axis of the foot being around the 2nd toe and MT. And that therefore when doing a TMTA, the hallux 1st MT should be bevelled inner (medially) and that the 3,4,5 should be bevelled on the lateral side, and that all should be bevelled on the plantar aspect

Nice images and descriptions of this being done with great attention to all the above detail (in case of TMTA) by ortho foot and ankle colleagues in Frimley.

Favours the Symes.

Would not do a Chopart.

Says if faced with the potential need for a Chopart, to instead choose between either a Symes or a BKA.

States that getting the flap and excision (removal of the calcaneum through the access wound without damaging what is left behind) is one of the most challenging operations that KJ does. Makes him sweat.

percutaneous DVA, by Paul Moxey.

percutaneous DVA

by Paul Moxey

Very comprehensive talk

Was the PI for PROMISE 1 in the UK

A total of 5 patients

Described the Limflow kit

Explained how the new basket retrieval kit has evolved from the prior technique of inflating a balloon in the vein, rupturing the balloon with the outback-type needle coming out from the arterial access, and thus trapping the needle and wire within the deflated balloon and thus effectively snaring the arterial access into the vein.

Talked about the great importance of realising that it takes 30 days, give or take, for the revascularisation benefit in terms of TcO2 and perfusion to start becoming functionally evident on the pDAV treated foot.

Recaps the failure of surgical DVA to have been partly due to the inability to treat the venous pinch points in the ankle and foot

Along those lines, showed one case where embolising away the SSV outflow appeared to help increase foot perfusion.

Surgeon performed crural angioplasty review from Dublin, by Prakash Madhavan

0820 - 0840

Surgeon performed crural angio

Madhavan

Clarence

Another excellent talk

No technical imagery

Essentially all about rationale and practice

Gave reasons why surgeon delivered crural angio makes sense for the patient

Stated that committing to this practice also meant the need to maintain one’s currency with cutting edge endo developments

From St James in Dublin

Their surgeon led practice of angioplasty is now 20 year strong

Distal bypasses, by Rob Davies.

0800 - 0820

BTK Rob Davies

Clarence

Excellent talk

Lots of illustrations / operative images / a few videos

All about open reconstruction BTK

Distal and ultra distal bypasses

Showed a couple of cadaveric exposures such as to the distal Peroneal

Some very good technical tips; such as when exposing for PT3 to always start at the top end of wound because the fragile plantar skin will fall apart if that is the initial incision

Similarly useful comments about offsetting the incision towards the DPA to one side and undermining towards DPA - RD says the DPA is often deeper than one expects

Says he has moved towards placing a more lateral incision when approaching the CFA in order to sweep all the lymphatics medially away from the vessel and minimise lymphatic complications

Mentioned the BEST CLI trial result at the start - that open revascularisation is more favoured over endo in patients who have good GSV

Spoke about the value of having multiple (or at least 2) operators in order to whittle down the duration of a distal bypass from 4-5 hours instead to 2-3

Spoke of the need for a patient anaesthetist who is a vascular specialist

RD prefers to use valulotomised vein for his bypasses, especially for very distal targets due to the ability to match the cablibres better; however also stated that the valves are much stronger in arm vein, due to (he says) previous venotomy related fibrosis etc, and therefore he tends to reverse rather than valvulotomise the arm vein when he uses that as conduit.

Seems to favour a different valvulotome device over the Le Maitre one.