Below-Knee Amputation

Excerpt

Lower-extremity amputation is performed when nonviable lower-extremity tissue is present for many reasons, including ischemia, infection, trauma, or malignancy. Lower-extremity amputation serves as a life-saving procedure. Lower limb ischemia, peripheral arterial disease, and diabetes are considered the primary causality of limb amputations in more than 50% of cases. Trauma is the next leading cause of lower-extremity amputations.

The second TransAtlantic Inter-Society Consensus (TASC II) working group reported the incidence of major amputations due to peripheral artery disease for up to 50 per 100,000 individuals annually.

A below-knee amputation (BKA) is a transtibial amputation that involves removing the foot, ankle joint, distal tibia, and fibula with related soft tissue structures. Generally, a BKA is preferred over an above-knee amputation (AKA), as the former has better rehabilitation and functional outcomes. Lower extremity amputation rates have declined recently, but 3500 trauma-related amputations are still performed annually in the United States. This surgical operation carries significant morbidity, yet it remains a treatment modality with vital clinical and often life-saving significance given appropriate indications.

Ernest M. Burgess first described the remarkable functional impact on preserving the transtibial zone.