Amputation alternatives in the lower limb, stressing combined management of the traumatized extremity

A methods approach for the care of the traumatic lower extremity amputee is presented, emphasizing joint surgical approach, specifics of management, ideal amputation levels, and functional rehabilitation. The role of the plastic surgeon with an interest in free flaps is ever increasing and has elevated the level and quality of traumatic extremity amputation. Therefore, an understanding by the plastic surgeon of the orthopedic, prosthetic, functional, and rehabilitation principles becomes as important as the orthopedic surgeon's appreciation of current microvascular reconstruction potential. Fortunately, large numbers of traumatic amputees are not available for study in the civilian population. With better-quality extremity salvage by free flap coverage, this number is decreasing. However, the problem will never be eliminated and efforts to produce the best possible amputation must be expended by the best techniques and personnel. Prosthetic management continues to develop with exciting innovations on the horizon. Currently, the modular concept of prosthetic design (Fig. 26) is a practical, cosmetic standard. Newer space-age materials and design changes should facilitate the functional potential of the traumatic amputee. Characteristics of traumatic lower extremity amputees are youth, immaturity, arrogance, and psychological instability, but they are usually cooperative following the initial shock and reality of the situation. These young people deserve our best efforts to allow them to become integrated into society and continue an active life, albeit passive or active (Fig. 27).