Skew flap technique in trans-tibial amputation.

The long posterior flap technique is an established technique for trans-tibial amputation in ischaemic limbs. Despite its success, it has a few drawbacks. It may be time-consuming and requires considerable planning, and at times the dog-ears cannot be avoided. The suture line passes over the distal end of the stump, which is usually a problem during prosthetic use. The skew flap technique retains the advantages of the long posterior flap technique and eliminates the difficulties of prosthetic fitting. The equal skin flaps are skewed so that the flaps become anteromedial and posterolateral, whereas the calf muscle flap remains long underneath the skewed skin flaps. The posterior muscles are brought anteriorly covering the cut ends of the bones and are buried in between the tibia and its anterior periosteum, by suturing their margins with the periosteum. The skew flap procedure was perceived in 1980 and was started at the Artificial Limb Centre, Pune in 1983 by the author. This procedure underwent many changes during the initial 5 years and by the end of April 1992, 85 trans-tibial amputations were performed using this technique. A 9-year follow-up of these patients, who had been using prostheses with ease and without any discomfort or problem, had been exceptionally good. Encouraged by the results, this technique is now being practised as routinely. By March 1998, a total of 125 such trans-tibial amputations had been performed in 119 patients, with excellent results.