Amputations

Abstract

The primary goal of amputation surgery is to preserve anatomy and maximize the function of the residual limb while minimizing potential future complications. This chapter will begin with the standard below-the-knee amputation (BKA) and follow through with less frequent amputations of the Ertl-modified BKA and midfoot amputations. This chapter will cover additional preoperative and postoperative instructions as this case differs from most other elective procedures within this textbook.

The standard below-the-knee amputation (BKA) is a frequent surgery that makes an appearance to the foot and ankle specialist’s operating room schedule. It is most often an “add-on” case, and the patients are frequently less healthy than the routine elective cases. Therefore, an efficient technique to perform the BKA can have dual benefits to the foot and ankle surgeon: efficiency of time and safety for the patient.

The Ertl modification of the below-the-knee amputation (BKA) was developed during the post-WWI era, due to the high volume of amputees created by blast injuries and wound complications. Its focus is an osteomyoplastic reconstruction of the lower extremity to facilitate end weight-bearing on the residual limb. Numerous benefits have been proposed with this form of end bearing modification, including establishing normal physiologic loading of the limb, fibular stabilization through osseous bridging between the tibia and fibula, and improved prosthetic fitting.

Patients presenting to the surgeon with unresolvable pathology isolated to the forefoot may be candidates for isolated amputation through the midfoot. With unresolvable diseases of the forefoot, an amputation of the midfoot allows the surgeon to preserve the ankle joint and hindfoot and potentially spares the need for a lower extremity prosthesis. The final portion of this chapter will describe the techniques of midfoot amputations.