Surgical techniques for conserving tissue and function in lower-limb amputation for trauma, infection, and vascular disease.

Certain factors regarding amputation level, such as the level of traumatic amputation, the position of a malignant tumor in a limb, or the level to which gangrene has progressed, cannot be changed. More important, in this regard, is the attitude of the surgeon toward amputation. This attitude determines the care with which the final level is selected, the manner in which the amputation is performed, and the way in which postoperative management, including prosthetic care, is handled. To achieve the desired long-term result for the amputee, the surgeon should view amputation as a reconstructive procedure rather than a destructive one, should be willing to do staged procedures to preserve potentially functional tissue, should be ready to consider and plan innovative surgical approaches, and should keep abreast of prosthetic advances as they affect surgical technique and postoperative management.