# Pilot Investigation of Ewing Amputation in Veterans with Peripheral Arterial Disease Undergoing Below Knee Amputation

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Diabetes and peripheral arterial disease (PAD) disproportionately affect our nation’s Veterans and are the
major contributors to major amputation in our Veterans. These dysvascular Veterans undergo ~ 1000 below
the knee or transtibial amputations annually. Our Veterans are more likely than younger/healthier patients to
suffer from prolonged wound healing, pain, and not regaining ambulatory status after amputation. Amputation
operations have not changed much in recent decades, but there are a number of exciting techniques that have
been developed and hold potential for improving Veteran outcomes. Ewing amputation (EA) is a technical
modification of transtibial amputation that may be able to provide a better limb for ambulation by recreating
agonist antagonist myoneural interface (AMI) under the gastrocnemius flap and improve pain control through
the creation of regenerative peripheral neural regenerative interfaces (RPNI). EA has been successfully pilot
tested in healthy, high-functioning individuals, but it has not been tested in dysvascular patients. This proposal
takes advantage of the phased clinical trial RFA to first test feasibility of EA in Veterans in a small group of
patients at a single VA site. If feasible, a 3 VA study will randomly compare the results of EA versus standard
transtibial amputation. The primary outcome is ambulation with a prosthesis. Safety parameters are 30-day
mortality and rate of revision to transfemoral amputation. Secondary outcomes are pain, balance, and quality
of life. Positive results will be disseminated across VAMCs broadly. In so doing, we will meet the tripartite goals
of the VHA Amputation System of Care (ASoC) to: 1) provide state of the art care; 2) maximize health and
independence; and 3) be the provider of choice for amputated Veterans [VHA Directive 1172.03(1)].

## Key facts

- **NIH application ID:** 10486237
- **Project number:** 1I01CX002366-01A1
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** LUKE Packard BREWSTER
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-07-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10486237

## Citation

> US National Institutes of Health, RePORTER application 10486237, Pilot Investigation of Ewing Amputation in Veterans with Peripheral Arterial Disease Undergoing Below Knee Amputation (1I01CX002366-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10486237. Licensed CC0.

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