This was the first time i saw this patient.  He had a Left BKA already, presents with a cold foot.  Ultimately gets vascular studies and no treatment.  Plan was to await full extent of ischemia to become apparent. Patient presents a few months later with the findings in the image below.

In an effort to preserve his ability to ambulate, a forefoot amputation was undertaken. Images below were form a follow up several weeks later.  It was certainly a rare opportunity to wee this each time in the ER and to participate in the excellent care of this very nice gentleman.