Skin grafts for the salvage of degloved below-knee amputation stumps

We present a series of six patients in whom a traumatic below-knee amputation was associated with significant degloving, such that there was inadequate local skin to achieve primary stump closure. In each case, skin grafts were used to cover the stump muscle flaps. The patients ranged in age from 21 years to 73 years; the mean hospital stay was 72 days and the mean follow-up was 48 months. Despite an average of five procedures to achieve stump healing and an average of 118 days to first limb fitting, all patients have achieved independent mobility with their prosthesis. All have had minor stump problems necessitating periods of time off their prosthesis. Three patients have required minor stump-revision surgery. The advantages of a below-knee amputation over an above-knee amputation compensate for these problems. The forgiving nature of modern prostheses has contributed to acceptable results in these patients, who had what may previously have been considered insufficiently durable stump cover.