A rationale for skew flaps in below-knee amputation surgery

McCollum, P. T.; Spence, V. A.; Walker, William F.; Murdoch, George

doi:10.3109/03093648509164713

Cited by 18 publications

(8 citation statements)

References 23 publications

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“…Thermography showed that the medial skin of the leg was better perfused than the lateral ( p < .001) along the saphenous nerve distribution. 11 Transcutaneous partial oxygen pressures were seen to fall following all amputations, with the greatest fall (11 mmHg) seen in long posterior flap amputations. 12 Either moving long posterior flap measurements medially or skewing the amputation stump would therefore seem logical in preserving blood flow and oxygen supply to the amputation suture line.…”

Section: Discussionmentioning

confidence: 92%

Skew flap for staged below-knee amputation in sepsis

et al. 2015

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Skew flap amputation was first described in the 1980s but was never as popular as the long posterior flap amputation. This report describes a staged below-knee amputation in sepsis, with pus throughout the leg and a lack of skin coverage. One benefit of skew flaps never previously published is the fact that the suture line is not directly over the tibia. Therefore, an open wound or incomplete skin coverage is not as important as in long posterior flaps where it often leads to bone exposure and revision amputation. These benefits were utilized in this case leading to stump healing.

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Section: Discussionmentioning

confidence: 92%

Skew flap for staged below-knee amputation in sepsis

et al. 2015

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“…In the modified Burgess procedure; skin markings, incision site and shape, tibial and fibular osteotomies and posterior flap formation were similar to the Burgess technique. As the difference from the Burgess technique, we have completely removed the tibialis anterior muscle which is most vulnerable to ischemia 22,23. Although resistant to ischemia, soleus presents a high risk of thrombus due to relative stasis formed in its large venous plexus when posterior flap is turned to the anterior,24 thus part of the soleus distal to the tibial osteotomy site was removed to prevent its rotation (Figure 3).…”

Section: Methodsmentioning

confidence: 99%

A Novel Technique for Transtibial Amputation in Chronic Occlusive Arterial Disease

Yurttaş

Kürklü

Demiralp

et al. 2009

Prosthetics &Amp; Orthotics International

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The aim of this study was to compare results of transtibial amputations performed using the Burgess or Modified Burgess techniques with those performed using the Bruckner technique. Transtibial amputation (TTA) was performed in 117 patients with Fontaine phase IV chronic arterial occlusion. Fifty-six patients with a mean age of 51. In the Burgess technique, all muscles in the amputation region were preserved and the stump was closed by a long posterior flap; whereas the entire tibialis anterior muscle and part of the soleus muscle distal to the amputation level were removed in the modified Burgess procedure. Stump revision was performed in nine cases (17.3%) amputated by the Burgess technique due to necrosis at the incision site and drainage caused by the peroneal and tibialis anterior muscles; however, two cases (3.6%) of the modified Burgess procedure required stump revision. The prosthesis caused skin maceration at the lateral side of the stump in five cases (9.6%) operated with the Burgess technique and in eight cases (14.5%) operated with the modified Burgess procedure. After the rehabilitation period, 43 patients (82.6%) in the Burgess group were mobilized without crutches in an average of 162.5 days; on the other hand 51 patients (% 92.7) in the modified Burgess group were similarly mobilized in an average of 101.5 days. Our retrospective study showed that the modified Burgess technique, with its advantages and disadvantages forms an alternative to the Burgess and Bru¨ckner techniques regarding TTAs.

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“…McCollum et al found that the muscles on the medial side of the calf, in patients with occlusive arterial disease, have an increased perfusion, compared to the lateral musculature. 40 Furthermore, Gray and Ng showed that the soleus muscle does not contribute to the perfusion of the posterior myocutaneous flap in patients with occlusive arterial disease. 29 The soleus muscle should be completely resected, because its vast venous plexus is at risk for the development of thrombosis secondary to a relative stasis created when the flap is anteriorly rotated.…”

Section: Rationale For the Modified Concept By Brücknermentioning

confidence: 99%

“…These findings have been confirmed by others. McCollum et al found that the muscles on the medial side of the calf, in patients with occlusive arterial disease, have an increased perfusion, compared to the lateral musculature 40 . Furthermore, Gray and Ng showed that the soleus muscle does not contribute to the perfusion of the posterior myocutaneous flap in patients with occlusive arterial disease 29 …”

Section: Introductionmentioning

confidence: 99%

Concepts of Transtibial Amputation: Burgess Technique Versus Modified Brückner Procedure

Stahel

Oberholzer

Morgan

et al. 2006

ANZ Journal of Surgery

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The technique of a long posterior myocutaneous flap described by Ernest M. Burgess in the late 1960s is one of the most frequent procedures for below-knee amputations worldwide. To account for some potential problems associated with this procedure in patients with occlusive arterial disease, Lutz Brückner developed a modified amputation technique for transtibial amputation in the 1980s. Although this new standardized procedure has been widely used in Germany, it is not well known outside central Europe, secondary to its lack of description in English published work. In this review article, we describe a comparison of the technical aspects of the Burgess procedure with the modified Brückner technique for transtibial amputations. In addition, the charts of 69 consecutive patients with end-stage occlusive arterial disease undergoing below-knee amputation by either of the two standardized procedures (Burgess, n = 29; Brückner, n = 40) were reviewed. The clinical results of the two procedures are reported and compared. Review of the German published work suggests that the two techniques for transtibial amputation in patients with occlusive arterial disease appear to have similar results. This is further supported by data from our own 10-year experience with 69 patients undergoing below-knee amputation by either of the two standardized procedures. This suggests that the Brückner technique is at least equivalent to the Burgess procedure with regard to the clinical outcome in patients with occlusive arterial disease. The potential advantages of the standardized modified Brückner procedure compared with the 'classical' Burgess technique for transtibial amputation remain to be assessed in prospective multicentre trials.

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A rationale for skew flaps in below-knee amputation surgery

Cited by 18 publications

References 23 publications

Skew flap for staged below-knee amputation in sepsis

Skew flap for staged below-knee amputation in sepsis

A Novel Technique for Transtibial Amputation in Chronic Occlusive Arterial Disease

Concepts of Transtibial Amputation: Burgess Technique Versus Modified Brückner Procedure

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