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A rationale for skew flaps in below-knee amputation surgery.

P T McCollum, V A Spence, W F Walker

Prosthetics and Orthotics International

|August 1, 1985

Summary

This study found significantly higher skin blood flow medially compared to laterally below the knee in patients with peripheral vascular disease. This suggests a medially based skin flap may improve below-knee amputation outcomes.

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Area of Science:

Vascular Surgery
Dermatology
Medical Imaging

Background:

Thermography shows medial to lateral thermal gradients in amputation level assessment.
The clinical significance of these thermal gradients regarding skin blood flow is not well understood.

Purpose of the Study:

To investigate if thermographic gradients reflect true medial to lateral skin blood flow differences.
To guide surgical planning for below-knee amputations.

Main Methods:

Prospective study of 21 patients with end-stage peripheral vascular disease undergoing amputation assessment.
Measurement of medial and lateral skin blood flow using intradermal radioisotope clearance technique.

Main Results:

A highly significant difference in skin blood flow was observed between medial and lateral aspects of the lower leg (t = 4.79; p < 0.001).

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Medial skin exhibited significantly higher blood flow than lateral skin.

Conclusions:

The findings support the hypothesis that thermal gradients correlate with blood flow.
A medially based posterior below-knee amputation skin flap may offer improved outcomes for select patients due to higher medial blood flow.