Skewflap versus long posterior flap in below-knee amputations: multicenter trial

Area of Science:

• Vascular Surgery
• Amputation Techniques
• Prosthetics

Background:

• End-stage occlusive vascular disease often necessitates below-knee amputation.
• Optimizing stump construction is crucial for successful prosthetic limb fitting and ambulation.
• Comparing alternative surgical techniques is essential for improving patient outcomes.

Purpose of the Study:

• To compare the efficacy of the skew flap technique versus the long posterior flap for below-knee amputation.
• To evaluate early and late outcomes, including mortality, wound healing, and prosthetic use.
• To determine if the skew flap offers comparable or superior results to the traditional long posterior flap.

Main Methods:

• A multicenter randomized trial involving 191 patients with end-stage occlusive vascular disease.
• Patients were randomized to either the skew flap (n=98) or long posterior flap (n=93) technique.
• Outcomes assessed included 30-day mortality, wound healing at 1 week, surgical revisions, prosthetic fitting, and walking ability at 6 months.

Main Results:

• No statistically significant differences were observed between the skew flap and long posterior flap groups in 30-day mortality (11% vs. 17%), primary wound healing (60% in both), or revision rates.
• At 6 months, prosthetic limb fitting was achieved in 84% of skew flap patients and 77% of long posterior flap patients.
• Walking ability was achieved in 78% of skew flap patients and 71% of long posterior flap patients, with no significant difference.

Conclusions:

• The skew flap technique is a viable and effective alternative for below-knee amputation.
• It demonstrates comparable outcomes to the long posterior flap in terms of mortality, wound healing, prosthetic use, and ambulation.
• The skew flap should be considered an excellent option for below-knee amputation surgery.