answers to level of amputation of below knee: message from Tom Da niels

answers to level of amputation of below knee: message from Tom Da niels

Rikus Van der meulen

5/14/2001

hello there

I was very pleased by all the answers I received on the level of
amputation subject

in general i can concluded that it is not a very easy question to answer
but the following does make some sense

considering the amputation in case of vascular patient we do have to admit
that
the most interesting level is in the proximal thirth of the BK
this means a level from 8 to 12 centimeters below the medial joint line
about three fingers below the tendons of the m. biceps femoris and the m.
semitendinosus

when you have less then 5 centimeters, a kneedisarticulation can be of more
functional use

good pre-operative investigation can be very usefull

talking about an amputation caused by a trauma or infection or a tumor
we need to create a stump as long as possible
although we do not can use several interesting prosthetic devices
the strength, its leverage, proprioceptive qualities, the reduced energy
consumption which influence the
functionality and the comfort of the prosthetic wearer are much more
beneficial in comparison of
a shorter stump
something to think about

a good alternative surgical procedure can be the ERTL procedure
it creates a good stump where partial distal contact is possible
it makes it possible to use myodesis of the muscles
which means that they still can be trained
and where the bloodcirculation can be influenced

that's about it
i hope it can be of some use

check out the references

greetings Tom

Waters, R. l., Perry, J., Antonelli, D., and Hislop, H.: Energy cost of
walking amputees: the influence of level of amputation, J. Bone Joint Surg.
58A:42-46, Jan., 1976.

Burgess, E. M.: Atlas of limb prosthetics, Surgical and Prosthetic
principles, Chap. 2.: General principles of amputation surgery, p. 14-18


McCollough, N. C., Harris, A. R., Hampton, F. L.: Atlas of limb prosthetics,
Surgical and Prosthetic principles, Chap. 23.: Below-knee amputation, p.
341-368

Baumgartner, R., Botta, P.: Amputation und Prothesenversorgung der unteren
Extremität, Chap. 3 Wahl der Amputationshöhe, p. 50-61

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http://www.prs-research.org/MLEA_web/chapter.2/chapter.2e.html

http://www.flexfoot.com/footnotes/fn2000_p8.html