Techniques for lower extremity amputation
- Venkat Kalapatapu, MD
Venkat Kalapatapu, MD
- Associate Professor of Clinical Surgery
- Division of Vascular Surgery
- Penn Presbyterian Medical Center
- University of Pennsylvania Health System
- Section Editors
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery, Texas A&M Health Science Center
- Vice Chair of Vascular Surgical Services, Baylor Heart and Vascular Hospital at Dallas
Lower extremity amputation is performed to remove ischemic, infected, or necrotic tissue or locally unresectable tumor and, at times, may be life-saving. The majority of lower extremity amputations are performed for lower extremity ischemia (peripheral artery disease, embolism) and diabetes mellitus. Extremity trauma is the second leading cause for amputation, and malignancy accounts for the remainder [1,2].
The techniques for major amputation and foot amputations are reviewed here. The indications for lower extremity amputation, preoperative and postoperative care, complications and outcomes are reviewed separately. (See "Lower extremity amputation".)
Hip and thigh — The hip joint is a multiaxial ball-and-socket joint. The ligamentous structures of the joint are the fibrous capsule, the acetabular labrum, the ligament of the head of the femur, iliofemoral, ischiofemoral, pubofemoral and the transverse acetabular ligament.
The muscles that surround the hip joint are divided into three groups: anterior, posterior, and inferior. The anterior group, lateral to medial, includes the rectus femoris, iliopsoas, and pectineus. Anterior to this group are the sartorius and tensor fascia lata. The posterior group consists of the piriformis, obturator internus, quadratus femoris, and obturator externus.
The muscles of the thigh are divided into three groups (figure 1): The anterior group consists of the sartorius, tensor fascia lata, and quadriceps femoris (vastus medialis, intermedius, and lateralis, rectus femoris); the medial group includes the gracilis, pectineus, and adductor longus, brevis and magnus; the posterior group consists of the biceps femoris, semitendinosus and semimembranosus. The adductor muscles insert into the posterolateral femur along a narrow ridge called the linea aspera.
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- SURGICAL ANATOMY
- Hip and thigh
- Ankle and foot
- GENERAL PRINCIPLES OF AMPUTATION
- Staged amputation
- - Cryoamputation
- General techniques
- MAJOR AMPUTATIONS
- Hip disarticulation
- Above-knee amputation
- Through-the-knee (knee disarticulation)
- Below-knee amputation
- - Posterior flap technique
- - Other flap techniques
- - Adjunctive techniques
- FOOT AMPUTATIONS
- Ankle disarticulation
- Midfoot and hindfoot amputations
- Transmetatarsal amputation
- Toe amputation
- - Simple
- - Ray
- DRESSINGS AND DRAINS
- SUMMARY AND RECOMMENDATIONS