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Modified Skew-Flap Below-Knee Amputation
Am J Orthop. 2007 March;36(3):123-126
Author and Disclosure Information
Amitabh J. Dwyer, MS Orth, Rajesh Paul, MS ORth, Maharaj Krishan Mam, MS Orth, D Orth, Jeewan Singh Prakash, MS Orth, and Richard Andre Gosselin, MD, MSc, MPH, FRCS(C), FAAOS
Dr. Dwyer is Reader, Dr. Paul and Dr. Mam are Professors, and Dr. Prakash is Reader, Department of Orthopedic Surgery, Christian Medical College and Hospital, Ludhiana, Panjab, India.
Dr. Gosselin is Visiting Professor, School of Public Health, University of California-Berkeley, Berkeley, California.
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.