Vascular

Below-Knee Amputation

BELOW-KNEE AMPUTATION (TRANSTIBIAL AMPUTATION)

Indication: Irreversible critical lower limb ischaemia with tissue loss or gangrene not amenable to revascularisation, or failed revascularisation. Also for diabetic foot with infection/osteomyelitis not amenable to local debridement. Preserving the knee joint significantly improves rehabilitation potential compared with above-knee amputation.

Patient Position: Supine.

Anaesthesia: General or regional (spinal).

Prophylactic Antibiotics: Broad-spectrum (IV).

Procedure:
1. Amputation level determined by clinical assessment of skin perfusion, transcutaneous oxygen levels, and Doppler pressures.
2. Long posterior skin flap technique (Burgess): skin incision marked with an anterior transverse incision at the level of bone transection and a long posterior flap.