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Below Knee Amputation Techniques Explained

The document outlines two types of skin flaps used in below knee amputation: the long posterior flap and the skew flap. It details the surgical procedures for each method, including incision techniques, blood vessel management, and post-operative care. The long posterior flap is noted for its simplicity, while the skew flap utilizes anatomical knowledge of skin blood supply for flap development.

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Harikrishnan S
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29 views9 pages

Below Knee Amputation Techniques Explained

The document outlines two types of skin flaps used in below knee amputation: the long posterior flap and the skew flap. It details the surgical procedures for each method, including incision techniques, blood vessel management, and post-operative care. The long posterior flap is noted for its simplicity, while the skew flap utilizes anatomical knowledge of skin blood supply for flap development.

Uploaded by

Harikrishnan S
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Below knee Amputation

Below knee amputation

 Two types of skin flaps are commonly used: Long posterior flap and
skew flap.
 Total length of the flap must be atleast one and a half times the
diameter of the leg at the point of bone section.
 The long posterior flap method is the older method and more popular
probably because of its relative simplicity.
Long posterior flap method

 Incision:
 Tibial tuberosity identified and a distance 10cm measured distally and
marked-Anterior landmark.
 The circumference measured at this landmark with a long suture tie
and this length divided into two thirds.
 Suture centred over anterior landmark so there is one third either side.
 Suture ends pulled directly posterior-Posterior limit of transverse
incision.
 The transverse incision is now marked.
 From the posterior limits,the incision extends longitudinally atleast half
the circumference of the leg at the level of anterior landmark.
 Line of incision is now extended transversely around the back of the
limb to join the distal ends of longitudinal incisions.
 After this an incision is made along the previously markedlines through
skin,subcutaneous fat and deep fascia.
 Anteriorly the incision is deepened to bone and the lateral and posterior
incisions are fashioned to leave the bulk of gastrocnemius muscle
attached to the flap.
 Blood vessels are identified and ligated.
 Nerves are not clamped,but pulled down gently and sharply transected
as high as possible.
 Vessels in nerves are ligated.
 Fibula is divided 2cm proximal to the level of tibial division using bone
cutters.
 Tibia is then clared and transected.
 long muscle/skin flap is tapered after removing the soleus muscle.
 The area is washed with saline to remove the bone fragments.
 The muscle and fascia are sutured with an absorbable material to bring
the flap over the bone ends.
 A suction drain is placed deep to the muscle
 A local anesthetic infusion stump catheter can be placed for
perioperative pain relief.
 Interrupted skin sutures are inserted.
 Gauze,wool and crepe bandages are used for stump dressing
Skew Flap Amputation

 Makes use of Anatomical knowledge of skin blood supply.


 Equally long fascial -cutaneous flaps are developed.and they join
anteriorly 2.5 cm from the tibial crest.and posteriorly at the exact
opposite point on the circumference of the leg.
 Division of bone and muscle similar to posterior flap method
 The gastrocnemius myoplastic flap is then sutured over the cut bone
end to the anterior tibial periosteum with absorbable sutures.
 Finally drainage and skin sutures are inserted and the limb is dressed

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