below knee amputation (BKA)

Etiology

• risk factors
  • peripheral arterial disease (RR=14)
  • microvascular disease (RR=4) (diabetes mellitus)
  • peripheral arterial disease + microvascular disease (RR=23)

Epidemiology

• among veterans, incident rate of lower-extremity amputation is 1.2 per 1000 person-years

Radiology

• angiography of limited prognostic value
  • if deep & superficial femoral vessels show occlusion, a BKA will probably not heal

Management

post-operative

• rigid dressing of plaster or fiberglass
  • prevents edema
  • enhances healing
  • protects limb
  • prevents knee flexion contraction
  • reduces discomfort
  • placed in OR
  • replace immediately after:
    • wound inspection
    • removal of stitches
    • edema occurs within minutes
• prosthesis
  • 6-10 weeks prior to fitting
  • requires less energy than swing-through crutch- assisted walking
  • 33% increase in energy consumption with ambulation over baseline
    • lightweight prosthesis (titanium) recommended for geriatric population

More general terms

• limb amputation

Additional terms

• prosthesis