title: Through-knee amputation in high-risk patients with vascular disease: indications, complications and rehabilitation.
abstract: During a 10-year period 104 patients (mean age 72 years) had 106 through-knee amputations. Indications for surgery were: limb gangrene, 67 (64 per cent); ischaemic ulceration, 22 (21 per cent); rest pain, 9; knee contractures, 6. Thirty patients had had previous unsuccessful vascular reconstructive surgery and five had had a failed femoral embolectomy. The through-knee disarticulation used lateral skin flaps. The mortality was 21 (20 per cent). Of the 83 survivors, 59 (71 per cent) underwent uncomplicated primary wound healing; 36 (43 per cent) of the survivors were unsuitable for rehabilitation on a prosthesis. The remaining 47 (57 per cent) were walking before discharge 30-130 days (mean 68 days) after amputation. Through-knee amputation is a rapid, relatively bloodless, amputation and is a useful debridement procedure. The many surgical and functional advantages, in conjunction with the recent reports of better rehabilitation compared with the above-knee or Gritti-Stokes amputation, suggests that the through-knee amputation deserves greater consideration.
authors.affiliation: Limb Surgery Unit, Queen Mary's University Hospital, London, UK.
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.forename: P
authors.initials: P
authors.lastname: Buttenshaw
authors.forename: M
authors.initials: M
authors.lastname: Mulcahy
authors.forename: K P
authors.initials: KP
authors.lastname: Robinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D001186:Artificial Limbs; D048909:Diabetes Complications; D005260:Female; D005734:Gangrene; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D007866:Leg / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design; D012307:Risk Factors; D013997:Time Factors; D014652:Vascular Diseases / Q000601:surgery*