Extract
Using the experience gained from taking care of World War II veterans with
amputations, Ernest Burgess taught us that amputation surgery is
reconstructive surgery. It is the first step in the rehabilitation process for
patients with an amputation and should be thought of in this way. An
amputation is often a more appropriate option than limb salvage, irrespective
of the underlying cause. The decision-making and selection of the amputation
level must be based on realistic expectations with regard to functional
outcome and must be adapted to both the disease process being treated and the
unique needs of the patient. Sometimes the amputation is done as a life-saving
procedure in a patient who is not expected to walk, but more often it is done
for a patient who should be able to return to a full active life. This lecture
addresses amputations done to return the patient to full activity. Our
purposes are to assist the reader in (1) establishing reasonable goals when
confronted with the question of limb salvage versus amputation, (2)
understanding the roles of the soft-tissue envelope and osseous platform in
the creation of a residual limb, (3) understanding the method of
weight-bearing within a prosthetic socket, and (4) determining whether a bone
bridge is a positive addition to a transtibial amputation.