Transcutaneous partial oxygen pressure changes following skew flap and Burgess-type below-knee amputations

W. C. Johnson, M. T. Watkins, J. Hamilton and D. Baldwin
Department of Surgery, Boston Veterans Affairs Medical Center, Boston University School of Medicine, Mass, USA.

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.