A standardised trans-tibial amputation method following chronic occlusive arterial disease

Abstract

The histo- and biochemical parameters of leg muscles from patients with chronic occlusive arterial disease were examined. The outcome of these tests indicated that it is not possible visually to determine the amputation level accurately at the time of surgery. These test results therefore encouraged the authors to develop a standardised surgical procedure for trans-tibia1 amputations. With this standardised technique specific musculature is resected to assure that no pathological tissues remain. This surgical prophylaxis is meant to prevent the development of gas gangrene and thus to obtain primary healing. Eighty-six trans-tibia1 amputations were performed and in 93% of these the knee joint was preserved.

Concepts of Transtibial Amputation: Burgess Technique Versus Modified Brückner Procedure

“…35,36 Overall, this modified procedure leads to a decreased risk of postoperative soft tissue complications in patients with stage IV occlusive arterial disease. 35,36 An example of a Brückner BKA residual limb is depicted in Figure 3.…”

“…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. 35 In cases when a high resection of the tibia is required (£2 cm below the tuberosity) complete disarticulation of the fibula leads to a stump, which allows earlier weight bearing. Complete resection of the fibula decreases the tension on the soft tissues that may be caused by abduction malposition of the proximal fibula based on the absent interosseus membrane.…”

“…1). 17,34,35 To our knowledge, no published report has compared the ‘classical’ Burgess technique with the modified Brückner procedure. In the present review, we stress the surgical aspects of these two techniques and present outcome data from a consecutive 10‐year experience of 69 patients undergoing BKA by either of these two procedures due to end‐stage occlusive arterial disease.…”

“…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 35 . In cases when a high resection of the tibia is required (≤2 cm below the tuberosity) complete disarticulation of the fibula leads to a stump, which allows earlier weight bearing.…”

“…In cases when a high resection of the tibia is required (≤2 cm below the tuberosity) complete disarticulation of the fibula leads to a stump, which allows earlier weight bearing. Complete resection of the fibula decreases the tension on the soft tissues that may be caused by abduction malposition of the proximal fibula based on the absent interosseus membrane 35,36 . Overall, this modified procedure leads to a decreased risk of postoperative soft tissue complications in patients with stage IV occlusive arterial disease 35,36 .…”