Below-knee Amputation



Below-knee Amputation












Figure 104-1 Skin Incision and Development of Flaps


Skin Incision and Development of Flaps (Fig. 104.1)


Technical Points

Plan a skin incision with a long posterior flap. The length of the posterior flap should approximate the transverse diameter of the leg. As extra length of flap can always be trimmed; it is advisable to make the flap too long at the initial incision. Divide the minimal soft tissues anterior to the tibia. Plan to divide the tibia about four fingerbreadths below the tibial tuberosity. If the amputation is being performed for trauma, a longer stump may be tailored. Generally, when amputation is done for ischemia, a shorter stump is desirable.

Identify and ligate the greater saphenous vein in the medial aspect of the anterior incision. Divide all soft tissues down to the tibia anteriorly and through the fascia of the muscles laterally.

To limit blood loss, do not create the posterior skin incision at this point.


Anatomic Points

The division of the tibia about four fingerbreadths inferior to the tibial tuberosity corresponds to approximately the level of the greatest circumference of the leg. At this location, the greater saphenous vein and accompanying saphenous nerve are located in the superficial fascia just posterior to the medial border of the tibia—that is, in the fascia overlying the tibial origin of the soleus muscle. No important structures lie in the superficial fascia anterior to the greater saphenous vein. The anteromedial surface of the tibia lies just deep to the superficial fascia. Hence, the anterior border of the tibia is a useful landmark, and no muscles must be divided to expose it.

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Jul 22, 2016 | Posted by in GENERAL SURGERY | Comments Off on Below-knee Amputation

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