title: Modified skew-flap below-knee amputation.
abstract: 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.
authors.affiliation: Department of Orthopedic Surgery, Christian Medical College and Hospital, Ludhiana, Panjab, India. amitabhdwyer@yahoo.com
authors.forename: Amitabh Jitendra
authors.initials: AJ
authors.lastname: Dwyer
authors.forename: Rajesh
authors.initials: R
authors.lastname: Paul
authors.forename: Maharaj Krishan
authors.initials: MK
authors.lastname: Mam
authors.forename: Jeewan Singh
authors.initials: JS
authors.lastname: Prakash
authors.forename: Richard Andre
authors.initials: RA
authors.lastname: Gosselin
mesh_terms: 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