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Figure 11. Infected above-knee amputation stump imaged with 111In-leukocytes. A 63 year old diabetic man on dialysis for end-stage renal disease developed severe peripheral vascular disese with gangrene of the left great toe resulting in a left below-knee amputation. His right foot became ischemic with gangrene of the great toe necessitating right below-knee amputation. To salvage the remainder of the limb the patient simultaneously underwent a right femoral-popliteal bypass. His post-operative course was complicated by ongoing stump infections with breakdown and acute rupture of an infected right femoral artery pseudoaneurysm. Unfortunately, the stump infection could not be managed medically and the patient eventually underwent a right above-knee amputation. Once again there was evidence of postoperative sepsis with low-grade fever and rising leukocyte count (up to 30.6x109/ L). The patient complained of considerable pain and tenderness in the right above-knee amputation stump but clinically the wound was described by numerous consultants as clean and not the source of the patient's complaints. An 111In-leukocyte scan was requested to exclude other occult sources of infections such as intraabdominal abscess or graft infection, and revealed striking and clinically unsuspected accumulation in the right thigh stump (arrow). (Note that the left below-knee amputation stump does not show any evidence of active inflammation or infection.) Ten days later the patient went for surgical debridement and multiple pockets of pus were found in the stump.

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