Skew flap technique in trans-tibial amputation

Area of Science:

• Surgical techniques
• Orthopedic surgery
• Vascular surgery

Background:

• The long posterior flap technique is standard for trans-tibial amputations in ischemic limbs.
• This technique has drawbacks including time consumption, planning complexity, dog-ear formation, and suture line issues impacting prosthetic use.

Purpose of the Study:

• To introduce and evaluate the skew flap technique for trans-tibial amputations.
• To overcome the limitations of the long posterior flap technique, particularly regarding prosthetic fitting.

Main Methods:

• The skew flap technique involves creating anteromedial and posterolateral skin flaps.
• Posterior calf muscles are advanced anteriorly to cover bone ends, sutured to the periosteum.
• The procedure was initiated in 1983 and refined over 5 years.

Main Results:

• 85 trans-tibial amputations were performed by April 1992 using the skew flap technique.
• A 9-year follow-up showed patients experienced comfortable and problem-free prosthetic use.
• By March 1998, 125 amputations were performed in 119 patients with excellent outcomes.

Conclusions:

• The skew flap technique is a successful modification for trans-tibial amputations.
• It retains the benefits of the long posterior flap while improving prosthetic integration and patient comfort.
• The technique is now routinely practiced due to its excellent long-term results.