Bone and muscular viability assessment before amputation: usefulness of bone scan and 99mTc sestamibi dual-phase scintigraphy.

Durante S, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-222258 Description Tc-sestamibi has been used to evaluate metabolic muscle abnormalities since 25 years. Uptake and retention in myocytes correlates with mitochondrial content and has been used to evaluate muscle functionality and viability. A 2-year-old boy presented with extensive musculoskeletal necrosis due to streptococcal septicaemia. Level of amputation of right arm was modified during surgery, necrosis being far more extensive than predicted by a preoperative MRI. Therefore, a bone scan was done to assess perfusion and bone viability before amputation of both legs (figure 1). Bone viability was demonstrated for both femurs and proximal left tibia. Muscle viability being essential for functionality, a two-phase Tc sestamibi