Recent trends in lower extremity amputation. Surgery and rehabilitation.

With the use of modern prosthetic appliances and the initiation of early ambulation, satisfactory function can be expected in the vast majority of below-knee amputees. The rehabilitation of the above-knee amputee is more difficult and the performance of these patients does not compare favorably with that of the below-the-knee amputee. Immediate postsurgical fitting appears to have resulted in a higher percentage of successful below-knee amputations in patients with peripheral vascular disease. The rigid dressing provided by the temporary prosthesis applied to the stump immediately after the amputation seems to control excessive edema and places the severed tissues in an environment more conducive to uneventful healing. Myoplastic techniques and early ambulation are not necessary prerequisites for the use of the immediate postsurgical fitting technique. Below-knee myoplasty should not be performed in patients with peripheral vascular disease because of its questionable value and the undesirable additional surgical trauma that this technique requires. Early weight-bearing ambulation is not a prerequisite for the use of the immediate postsurgical fitting technique and may be instituted only in cases in which the patients' general condition, balance, and coordination are sufficiently intact to permit supervised instructions. The application of the temporary pylon requires wide prosthetic experience and extreme care.