Amputationstechnik und Prothesenversorgung der Kniegelenksexartikulation bei nichtrekonstruierbarem Oberschenkelarterienverschluß

Summary

In critical limb ischemia reconstructive surgery and percutaneous catheter procedures may effect a reduction of amputation rates up to 50%. If ischemia still endangers the limb and the possibility of revascularization procedures has been excluded, amputation is finally unavoidable.

If below-knee amputation is impossible, we prefer through-knee amputation that combines minor operative trauma and the present good fitting of an artificial limb. At this amputation level satisfactory wound healing presumes a patent profunda femoris and aortoiliac vessels without extensive occlusions.

From 1987 to 1991, we carried out 65 through-knee amputations. Since amputation was the final procedure after all reconstructive procedures had failed in more than 2/3 of the patients, healing by secondary intention was relatively frequent (45%). Half of these patients were treated conservatively or by skin and subcutaneous tissue revision. Twenty-eight percent had to be reamputated at the condylus level where satisfactory mobility aided by prosthesis can still be achieved. In 24% (or 10.9% of all patients), we had to convert through-knee amputation into one above the knee. The postoperative mortality rate was 15%.