Below-knee amputation in patients with vascular disease and prosthetic fitting problems.

A study was made of 544 cases with lower limb deficiencies caused by obliterative diseases; 262 cases were below-knee amputees. Of these, 106 (40%) were amputees transferred from other clinics for prosthetic fitting; in 156 cases (60%) the amputations were performed in the Institute. Amputations were carried out using one of two techniques according to the state of arterial and collateral circulation. The posterior flap below-knee amputation (Burgess, 1969) was employed in 94 cases, the other 62 amputations were carried out using a modification of that technique which was characterized by the formation of a musculo-fascia-cutaneous flap. The stump wound healed by first intention in 127 patients (81.4%), by second intention in 18 (11.5%) and in 11 cases (7.1%) the wounds failed to heal. Successful prosthetic fitting and walking training was achieved in 91.3% of amputees and 67.2% were returned to productive work.