title: Functional outcome after redo below-knee amputation.
abstract: BACKGROUND
  Nonhealing below-knee amputation (BKA) necessitates redo BKA or conversion to above-knee amputation (AKA). Outcomes after redo BKA remain poorly defined. We hypothesized that in selected patients redo BKA results in favorable functional outcomes.
  
  
  METHODS
  Patients undergoing redo BKA at a single institution during 4 years were reviewed. A concurrent cohort proceeding directly to ipsilateral AKA served as comparative controls.
  
  
  RESULTS
  Of 138 BKAs, 23 (17%) failed to heal primarily. Baseline demographics and medical comorbidities were similar between groups. Clinicians selected 14 for redo BKA and 9 for ipsilateral AKA. Eight (57%) of those undergoing redo BKA had a history of minor stump trauma and 13 (93%) had a palpable popliteal pulse, compared with no trauma (P = 0.007) and 4 (44%, P = 0.018) palpable popliteal pulses in the AKA group. Functionally, 86% of redo-BKA patients returned home, all eventually healed, and 86% walked, whereas none in the AKA group walked.
  
  
  CONCLUSIONS
  In selected patients, redo BKA yields excellent functional outcomes. A history of minor stump trauma and a palpable popliteal pulse favor redo BKA compared with conversion to AKA.
authors.affiliation: University of Florida College of Medicine and the Malcom Randall VAMC, P.O. Box 100286, Gainesville, FL 32610, USA.
authors.forename: Chad N
authors.initials: CN
authors.lastname: Stasik
authors.forename: Scott A
authors.initials: SA
authors.lastname: Berceli
authors.forename: Peter R
authors.initials: PR
authors.lastname: Nelson
authors.forename: W Anthony
authors.initials: WA
authors.lastname: Lee
authors.forename: C Keith
authors.initials: CK
authors.lastname: Ozaki
mesh_terms: D000203:Activities of Daily Living; D000671:Amputation, Surgical / Q000379:methods*; D000672:Amputation Stumps / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function; D012086:Reoperation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*