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Gritti-Stokes Amputation in the Trauma Patient: Tips and Techniques
Benjamin C Taylor1, Attila Poka1, Sanjay Mehta1
1Department of Orthopedic Surgery, Grant Medical Center, 285 East State Street, Suite 500, Columbus, OH 43215. E-mail address for B.C. Taylor: drbentaylor@gmail.com.
Introduction:
The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues.
Step 1 Preoperative Planning:
As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure.
Step 2 Flap Design:
Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure.
Step 3 Soft-Tissue Dissection:
Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain.
Step 4 Distal Femoral And Patellar Cuts:
Use a high-speed saw to transect the femur and patella.
Step 5 Posterior Dissection:
Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures.
Step 6 Patellofemoral Arthrodesis:
Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture.
Step 7 Soft-Tissue Closure:
Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion.
Step 8 Postoperative Management:
Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes.
Results:
The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium.
What To Watch For:
IndicationsContraindicationsPitfalls & Challenges.
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