Below-knee Amputation with Medial and Lateral Skin Flaps

Abstract

Background: Progress in multidisciplinary therapy has led to a trend to avoid below-knee amputation for critical limb ischemia. However, there are still serious cases in which such amputation must be performed. In typical below-knee amputation cases, the surgical wound is most commonly closed using anterior and posterior skin flaps, but delayed healing is not unusual in critical limb ischemia cases. One cause for the delayed healing of wound margins is thought to be the difference in the length and thickness of the wound margins between the anterior and posterior skin flaps. Methods: Four critical limb ischemia patients who were receiving hemodialysis for diabetic renal failure were treated with below-knee amputation using medial and lateral skin flaps of similar lengths and thicknesses. Result: All patients achieved satisfactory healing by wound closure. Conclusions: In critical limb ischemia patients undergoing maintenance hemodialysis for diabetic renal failure, medial and lateral flaps may be a viable option in below-knee amputation provided the patients are not candidates for postoperative prosthesis, such as elderly patients with preoperative gait difficulty.