Primary Closure of Below-Knee Amputation Stumps: A Prospective Study of Sixty-Two Cases

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      Between January 1, 1985, and December 31, 1988, we prospectively studied the outcome of 62 consecutive below-knee amputations with primary closure in 56 patients. There were 35 men and 21 women; mean age was 70 years. Above-knee amputation was performed for occlusion of the profunda femoris artery, acute thrombosis of a popliteal aneurysm with inadequate sural artery vascularity, intractable knee flexion contracture, suspended ischemia, and occasionally, when ischemia was found intraoperatively to extend proximally during below-knee amputation. Bedridden patients deemed unfit for prosthetic devices were also candidates for above-knee amputation. Fifty-four lower extremities (87%) were gangrenous and rest pain was present in eight patients (13%). Twenty-nine limbs (47%) were amputated primarily, 33 (53%) after failure of one or more revascularization procedures. Six patients had bilateral amputation. Forty patients (71%) were diabetic. Mean hospital stay was five days. Fifteen patients (27%) died during a mean follow-up period of 29 months. Eleven stumps (17.5%) required reoperation: five for postoperative infection, four for wound breakdown after a fall, and two for secondary abscess. Three secondary above-knee amputations (5%) were necessary. Of 44 below-knee amputations in diabetic patients, one had to be revised at the level of the thigh. Of 33 amputations after revascularization failure, one secondary above-knee amputation was necessary. Restoration of preischemic status was achieved after a mean of 58 days. Upon patient discharge from a rehabilitation center, 44 stumps (81%) were suitable to be fitted with prostheses. Compared with the open-stump technique, primary closure of below-knee amputation stumps reduces healing time without an increased reoperation rate. Hospitalization is short and reestablishment of patient autonomy is rapid.

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      1. Cormier JM. Amputation d'indication vasculaire. Encycl. Méd. Chir., Paris, Technique chirurgicale, Chirurgie Vasculaire, 1973;4.3.05,44125.

        • Langeron P
        • Rougee J
        Les amputations pour artérite: critères pour le choix du niveau d'amputation.
        J Chir. 1976; 111: 307-318
        • Baumgartner R
        Les amputations chez le vieillard.
        Rev Med. 1983; 10: 481-483
        • Barral X
        • Youvarlakis PH
        • Boissier CH
        Pontages en PTFE à pario mince sous le genou: étude préliminaire de 53 cas.
        Ann Chir Vasc. 1986; 1: 347-350
        • Winem MS
        • Amundsen T
        Treatment of phantom limb pain with T.E.N.S..
        Pain. 1982; 12: 299-300
        • Burgess EM
        • Romano RL
        • Zettl JH
        Amputation management utilizing immediate post-surgical prosthetic fitting.
        Prosthetics International. 1968; 3: 28-37
        • Berlemont M
        Appareillage immédiat.
        Ann Med Phys. 1972; 15: 98-140
        • Andreassian B
        • Broutard JC
        • Desmonts JM
        Les amputations du membre inférieur chez l'artéritique.
        Ann Chir. 1972; 26: 215-223
        • Rubin JR
        • Yao JST
        • Thompson RG
        • et al.
        Management of infection in major amputation stumps after failed femoro-distal grafts.
        Surgery. 1985; 95: 810-815
        • Cormier JM
        • Amar E
        Amputation de jambe d'indication vasculaire: techniques, indications, résultats.
        J Chir. 1973; 106: 425-440