What are the indications for limb amputation? Which is the commonest in the UK?

• Lower limb ischaemia secondary to atherosclerosis and/or diabetes is by far the commonest indication for amputation in the UK

• Trauma which is the commonest indication in the Third World

• Infection

• Malignancy

• Congenital deformity

What types of lower limb amputation do you know?

• Hip disarticulation or hindquarter amputation

• Transfemoral or above knee amputation (AKA)

• Through knee amputation

• Transtibial or below knee amputation (BKA)

• Through ankle or Syme's amputation

• Partial foot amputations

What pre-operative measures should be taken?

This is an entirely multidisciplinary process. All the members of the team (physiotherapy, occupational therapy (OT), rehabilitation specialist, prosthetic specialist, nursing staff, psychologists as well as the surgeon) must be involved and if possible meet the patient prior to surgery.

The level of amputation must be decided upon. This depends on the patients “rehabilitation potential”, degree of tissue compromise, and severity and pattern of the vascular disease.

Finally a careful anaesthetic assessment is made, bearing in mind that these patients may have atherosclerosis affecting their renal, coronary and cerebral vasculture as well as other co-morbid factors such as hypertension and diabetes. They may even be heavy smokers with associated pulmonary compromise.

Name two common techniques used for a BKA

1. Long posterior flap (the Burgess and Romano technique)

2. Skew flap

How do you perform a BKA?

Position This is supine with the affected leg in a knee-flexed position.