February, 2015 | Master Of Medicine

Monthly Archives: February 2015

Below Knee Amputation-Burgess Long posterior flap technique

The Burgess technique is the most frequently used technique in BK amputation.The well vascularized myocutaneous flap consists of gastrocnemius, partial soleus and posterior skin.

Technique

Incision

Anterior skin incision should be located 12 cm (one handbreadth) below tibial tuberosity, skin incision should be continued transversley for a distance approximately 1/3rd of calf circumference to minimize formation of dog ears. Skin incision should be extended vertically for a distance approx one and half times the length of transverse incision. The posterior flap is then completed with a transverse incision at this level.The skin incision is then extended through the fascia throughout, with division of great saphenous vein.

Division of muscles

The anterior compartment muscles(Tibialis anterior.EHL,EDL and fibularis longus) are divided at the same level as the anterior incision.Central in the anterior compartment is anterior tibial artery and vein and deep peroneal nerve.The vessels are suture ligated and nerve is transected under tension.The tibia is then cleared and interosseus membrane is incised sharply.The tibia is divided at or just proximal to the skin incision with an anterior bevel.The lateral compartment muscles(fibularis longus and brevis) are divided to expose fibula.Fibula is divided 1-2cm proximal to level of  tibial transection.

Flap closure

The posterior compartment muscles( Soleus and Gastrocnemius) are divided obliquely to create a posterior muscle flap.Enough soleus should be removed to allow flap closure. The posterior tibial and peroneal vessels are suture ligated .The fascial edges are closed with interrupted sutures and skin closed with mattress sutures.Elasto crepe bandage should be applied to mould the stump.

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