Pirogoff Amputation for Limb Salvage in Maggot-Infested Diabetic Foot Ulcer: A Case Report and Systematic Review

Abstract

Background
Severe diabetic foot infection is a leading cause of non-traumatic lower-limb amputation worldwide.
While below-knee amputation is frequently performed for advanced infection, limb-sparing procedures
that preserve limb length and allow end-bearing may offer improved functional outcomes in selected
patients. Pirogoff amputation is a hindfoot amputation that preserves the calcaneus and heel pad,
allowing creation of a stable end-bearing stump through tibiocalcaneal fusion.
Objective
To systematically review the available literature on Pirogoff amputation in diabetic foot disease and
present a case demonstrating its role as a limb-sparing alternative in severe diabetic foot infection.
Methods
A systematic review was conducted according to PRISMA 2020 guidelines. Electronic databases
including PubMed, Scopus, and Google Scholar were searched from database inception to March 2026
using predefined search terms related to Pirogoff amputation and diabetic foot infection. Studies
reporting clinical outcomes of Pirogoff or modified Pirogoff amputation were included. Reviewers
performed screening and eligibility assessment independently.
Results
The search yielded 2603 records, of which 23 studies met the inclusion criteria for qualitative
synthesis. Most studies were case reports or case series describing modified Pirogoff techniques. The
literature consistently indicates that successful outcomes are closely associated with preservation of a
viable heel pad and adequate hindfoot perfusion, enabling creation of a durable end-bearing stump.
Case Presentation
A 55-year-old man with poorly controlled diabetes presented with severe infection of the left foot and
maggot infestation following a non-healing ulcer after a rat bite. Pirogoff amputation was performed
due to preserved hindfoot viability.
Conclusion
Pirogoff amputation represents a valuable limb-sparing option in selected patients with severe diabetic
foot infection. Evidence from the literature and the present case indicates that successful limb salvage
depends primarily on preservation of a healthy heel pad and viable hindfoot tissues.