Transtibial amputation using a medially based flap

A technique is described which allows salvage of the knee joint in dysvascular patients who have marginal skin viability at below-knee level and who would otherwise require an above-knee amputation. The rationale for this technique is based on the vascular assessment which shows that there is frequently a significant medical to lateral skin blood flow gradient below the knee. Thus, a flap based on the more vascular medial skin is advocated. In 27 out of 34 'at risk' patients treated by the technique, the knee joint was successfully salvaged allowing early prosthetic fitting and mobilization.