Below-knee amputation using a medial saphenous artery-based skin flap

Area of Science:

• Surgical techniques
• Orthopedic surgery
• Amputation procedures

Background:

• Conventional below-knee (BK) amputation techniques, including the long posterior flap or skew-type amputation, are not suitable for all patients.
• A modified BK amputation was developed to address limitations in stump preservation for specific patient groups.

Purpose of the Study:

• To evaluate the efficacy and outcomes of a modified BK amputation utilizing a medial saphenous artery-based skin flap.
• To determine the suitability of this technique as an alternative for patients with contraindications to standard amputation methods.

Main Methods:

• A medial skin flap was designed based on the saphenous artery, with specific margins and length relative to the tibial crest and calf.
• The posterior muscle mass was advanced to cover the bony stump, and the medial skin flap was used for lateral defect coverage.
• The procedure was performed using standard BK amputation techniques following flap elevation.

Main Results:

• The modified BK amputation was successfully performed on nine patients (4 female, 5 male; age range 44-74 years).
• Complete survival of all skin flaps was observed, with no major complications reported.
• One patient experienced a minor wound infection, indicating a high success rate.

Conclusions:

• The medial saphenous artery-based flap, perfused by a direct cutaneous vessel and innervated by the saphenous nerve, is a valuable alternative in modified BK amputations.
• This technique provides a functional BK stump when conventional methods are unsuitable.
• The study demonstrates the successful application and positive outcomes of this modified amputation approach.