title: Limb salvage after subtotal supramalleolar amputation by initial shortening followed by tibial lengthening.
abstract: BACKGROUND
  We present a patient with a subtotal traumatic supramalleolar amputation of the leg, which was initially treated by a vascular reconstruction with deliberate bone and soft-tissue shortening.
  
  
  METHODS
  To correct the ensuing complex deformity, which consisted of a varus hindfoot, leg length discrepancy and equinus, a staged reconstruction was planned. Initially, the hindfoot varus, in presence of a stiff ankle, was corrected by a supramalleolar osteotomy, followed by a Wagner distraction and finally a correction of the equinus.
  
  
  RESULTS
  After a relatively long period of normal functioning, she regained painful minimal ankle function, which necessitated ankle fusion and correction of a pronation deformity. At the most recent follow-up 13 years after the injury, the patient is fully functional and has near normal leg length.
  
  
  CONCLUSIONS
  Although a mangled lower extremity is often a candidate for primary amputation allowing early rehabilitation, in certain cases a good result can be obtained by a creative strategy.
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, G4 Noord, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. orthopaedie@amc.uva.nl
authors.forename: R K
authors.initials: RK
authors.lastname: Marti
authors.forename: J S
authors.initials: JS
authors.lastname: de Vries
authors.forename: P
authors.initials: P
authors.lastname: Kloen
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000842:Ankle / Q000601:surgery; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D007870:Leg Length Inequality / Q000209:etiology / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D010027:Osteotomy; D012086:Reoperation; D013977:Tibia / Q000601:surgery*; D014656:Vascular Surgical Procedures