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Willard C. Johnson, MD; Michael T. Watkins, MD; Janis Hamilton, RN; Donna Baldwin, RN

Arch Surg. 1997;132(3):261-263.

Abstract
Objective
To evaluate the degree of flap hypoxia following different types of below-knee amputations.

Design
Prospective preoperative and postoperative measurements of transcutaneous partial oxygen pressure (TcPO2) at the site of amputation in 10 consecutive patients who underwent a Burgess-type below-knee amputation (group 1) and in 10 consecutive patients who underwent a skew flap amputation (group 2).

Setting
An academic, tertiary care Veterans Affairs medical center.

Patients
Individuals with severe arterial occlusive disease of the lower extremity, in many of whom vascular reconstruction has failed.

Intervention
Measurements of TcPO₂ (in millimeters of mercury).

Main Outcome Measurement
The decrease in TcPO₂ associated with the different "flaps" of a Burgess-type below-knee amputation.

Results
In all skin flaps, regardless of the type of amputation, an early postoperative reduction of the TcPO₂ was noted. The greatest reduction (11 mm Hg) and persistence at 20 postoperative days were noted in posterior flaps.

Conclusions
Strict conformity to the Burgess-type of below-knee flap design may not provide an optimal incisional blood supply. Consideration should be given to the skew flap technique in patients who require amputation for severe lower limb arterial insufficiency.

Arch Surg. 1997;132:261-263

Author Affiliations
From the Department of Surgery, Vascular Section, the Boston Veterans Affairs Medical Center, Boston University School of Medicine, Boston, Mass.

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