Wedge resection of amputation stumps. A valuable salvage procedure

Medial gastrocnemius muscle flap for the reconstruction of unhealed amputation stumps

OBJECTIVE

Unhealed amputation stumps after transtibial amputation are common and often require reamputation futher up the leg. The aim of our study is to describe our experience with medial gastrocnemius muscle flap coverage following a transtibial amputation.

METHOD

We retrospectively examined the records of patients who had an unhealed transtibial amputation stump who were then treated with a medial gastrocnemius muscle flap.

RESULTS

We identified seven patients, all had diabetes mellitus and an initial amputation by the long posterior flap technique. All of the flap reconstructions of the amputation stumps ultimately survived. A mild knee flexion contracture was seen in two amputees, whereas full range of motion in the knee was observed in the remaining five amputees. None have required further surgical intervention.

CONCLUSION

Medial head of gastrocnemious flap is an option for the reconstruction of the unhealed stump, particularly in the cases where stump shortening will not be feasible.

Dundee revisited--25 years of a total amputee service

The Dundee Limb Fitting Centre has provided an integrated rehabilitation programme for the amputee since 1965. A review of 1846 primary amputees is discussed. During this period a dramatic change in the above-knee/below-knee (AK/BK) ratio has been achieved with 71% BK and 26% AK occurring in 1989. Over 80% of all amputees, the majority being elderly with peripheral vascular disease, were successfully fitted with a prosthesis. Final discharge home or to a residential home for the elderly was achieved in 76.2% of cases with 3.6% dying in the Unit. Bilateral amputation occurred in 18% of cases of whom 48% were BK-BK. Overall 66% were successfully fitted with a prosthesis. The results demonstrate the advantages of an integrated approach to the amputation and consequent rehabilitation.