The Brückner standardized below knee amputation procedure following chronic occlusive arterial disease

Brückner, Lutz

doi:10.1007/bf02620534

Cited by 4 publications

(9 citation statements)

References 6 publications

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“…25 He claimed phasic muscles were vulnerable to ischemia as the cause of secondary muscle necrosis and thus recommended excision of all muscles of the anterior and lateral compartment. He has also excised fibula to fill the defect, to prevent abduction deformity of fibula 8,24 and closed the stump with complete medial part of gastrocnemius and a part of lateral gastrocnemius. But in this type of amputation where anterior and lateral compartment is completely removed together with fibula and a short stump is left, Jones reported poor adaptation to prosthesis and skin ulcerations on the lateral-distal part of the stump.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Other studies showed that soleus muscle has a large venous plexus and if posterior flap of stump is rotated to anterior, relative stasis is formed within the plexus that leads to thrombus formation and subsequent necrosis. 24 In the modified Burgess technique, we removed these two muscles carrying high risk of necrosis, but preserved the muscles of the lateral compartment and the fibula. Only 3.6% of the cases amputated by this technique required revision surgery whereas this number was as high as 17.2% in the Burgess technique.…”

Section: Discussionmentioning

confidence: 99%

“…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: Surgical Techniquementioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

See 1 more Smart Citation

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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“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

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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Long‐term Results of Through‐knee Amputation with Dorsal Musculocutaneous Flap in Patients with End‐stage Arterial Occlusive Disease

et al. 2004

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A modified technique of knee joint disarticulation using a dorsal musculocutaneous flap of the gastrocnemius muscle was first described in 1985. The operative results in 66 patients (33 women, 33 men; mean age 66.7 +/- 11.3 years, range 42-93 years) with gangrene due to peripheral vascular disease with 69 knee disarticulations are reported. After a mean survival period of 35.2 months (0-116 months), 88% ( n = 58) of the patients had died owing to cardiopulmonary reasons. The in-hospital 48-day mortality was 9%. Nine patients (14%) underwent reamputation at the above-knee level, and five patients underwent operative revision of the soft tissue. After discharge from the hospital, 35 of 60 patients (58%) were able to walk with the aid of a prosthesis. We conclude that knee disarticulation with the use of a myocutaneous gastrocnemius flap is a safe, functionally acceptable operative method in high risk vascular patients.

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The Brückner standardized below knee amputation procedure following chronic occlusive arterial disease

Cited by 4 publications

References 6 publications

A Novel Technique for Transtibial Amputation in Chronic Occlusive Arterial Disease

A Novel Technique for Transtibial Amputation in Chronic Occlusive Arterial Disease

Concepts of Transtibial Amputation: Burgess Technique Versus Modified Brückner Procedure

Long‐term Results of Through‐knee Amputation with Dorsal Musculocutaneous Flap in Patients with End‐stage Arterial Occlusive Disease

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