Below-knee amputation: A modern approach

Abstract

Immediate and long-term results of 113 belowknee amputations in 103 patients are presented to justify a comprehensive program of management that includes an objective method for determining amputation level with xenon 133 clearance, precise surgical technic, immediate postoperative prosthesis, and an aggressive program of rehabilitation. Prediction of healing of the last 30 below-knee amputations was 100 per cent successful, showing the value of 133Xe clearance for determination of amputation level. Zero per cent thirty-day mortality and 100 per cent prosthetic rehabilitation of patients on belowknee prostheses justifies the use of immediate postoperative prosthesis. Long-term follow-up of our patients demonstrates that the five year survival rate of diabetic patients is poor (39 per cent) compared with the nondiabetic amputee (75 per cent) who approached the survival of the normal, age-adjusted male population (85 per cent). The fact that 75 per cent of patients were alive after five years and were still independently ambulatory on their prostheses is final testimony to the value of the program.