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We would like to thank Dr Beard for his interest and kind comments regarding our article “Through-knee amputation in patients with peripheral arterial disease: A review of 50 cases”. Indeed it is surprising that the through-knee amputation for patients with peripheral vascular disease has apparently flourished in Europe and has been abandoned in the United States. Over the last two decades, a number of articles have been published reporting the healing rates and rehabilitation outcome of the standard through-knee and Gritti-Stokes amputation.1Yusuf S.W. Baker D.M. Wenham P.W. Makin G.S. Hopkinson B.R. Role of Gritti-Stokes amputation in peripheral vascular disease.Ann R Coll Surg Engl. 1997; 79: 102-104PubMed Google Scholar, 2Siriwardena G.J. Bertrand P.V. Factors influencing rehabilitation of arteriosclerotic lower limb amputees.J Rehabil Res Dev. 1991; 28: 35-44Crossref PubMed Google Scholar, 3Moran B.J. Buttenshaw P. Mulcahy M. Robinson K.P. Through-knee amputation in high-risk patients with vascular disease: indications, complications, and rehabilitation.Br J Surg. 1990; 77: 1118-1120Crossref PubMed Scopus (25) Google Scholar, 4Houghton A. Allen A. Luff R. McColl I. Rehabilitation after lower limb amputation: a comparative study of above-knee, through-knee, and Gritti-Stokes amputations.Br J Surg. 1989; 76: 622-624Crossref PubMed Scopus (59) Google Scholar The conflicting conclusions derived from these largely retrospective studies regarding the superiority of one amputation technique over the other are probably related to differences in patient selection, procedure indications, and surgical technique. The modified Mazet through-knee amputation technique described by our article has significant advantages to the standard through-knee amputation technique reported in these previous series. By shaving the femoral condyles and removing the patella, a conical stump is created thereby allowing use of a suction socket which is easy to apply and avoids the belts and straps necessary to don the above-knee prosthesis. Furthermore, the technique minimizes the length of the tissue flaps needed for wound closure resulting in an acceptable wound healing rate of 81%. We have no experience with the Gritti-Stokes amputation. Dr Beard utilizes this amputation technique primarily for patients who are not candidates for prosthesis-wearing. In our practice, we have performed above-knee amputation for patients who are nonambulatory and have reserved the through-knee amputation for patients who are candidates for prosthesis ambulation. Dr Beard provides a compelling argument for the use of the Gritti-Stokes amputation, particularly for the nonambulatory patient. Regarding “Through-knee amputation in patients with peripheral arterial disease: A review of 50 cases”Journal of Vascular SurgeryVol. 49Issue 3PreviewIn the article by Morse et al,1 the authors raise the profile of through-knee amputation for unreconstructable peripheral arterial disease in North America. Through-knee amputation (TKA) has become increasingly popular in Europe, as the authors point out in their article. At the Sheffield Vascular Institute, we prefer the modified Gritti-Stokes amputation.2 This has similar advantages to the modified Mazet technique used by the authors, in that it avoids the high incidence of wound complications and synovial leaks associated with preservation of the femoral condyles. Full-Text PDF Open Archive