Modified skew-flap below-knee amputation.
Between 1999 and 2001, 35 consecutive patients with diabetes (mean age, 59.4 years) were treated prospectively with a modified skew-flap below-knee amputation. The technique, results, and follow-up are described. By a mean follow-up of 3.5 years, 3 patients required below-knee amputation of the opposite extremity, 4 expired, and 28 were ambulating with a below-knee prosthesis. The modification has several advantages: A tibialis anterior muscle cushion on the distal end of the tibia prevents bone protrusion; anterior skin flaps made by the initial linear anterior incision prevent tension at the suture line; and oblique myocutaneous flaps avoid muscle trimming and prevent shearing of fascial plexuses at closure, thus improving wound healing.
Dwyer
Amitabh Jitendra
AJ
Department of Orthopedic Surgery, Christian Medical College and Hospital, Ludhiana, Panjab, India. amitabhdwyer@yahoo.com
Paul
Rajesh
R
Mam
Maharaj Krishan
MK
Prakash
Jeewan Singh
JS
Gosselin
Richard Andre
RA
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000672:Amputation Stumps / Q000098:blood supply*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery; D003925:Diabetic Angiopathies / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000473:pathology; D005734:Gangrene / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007717:Knee; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D011446:Prospective Studies; D013524:Surgical Flaps; D013977:Tibia / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome