Early and long-term outcomes following long posterior flap vs. skew flap for below knee amputations

Lara Jesani, Brenig Gwilym, Stephanie Germain, Hannah Jesani, Amy Stimpson, Alison Lennon, Ian Massey, Christopher Twine, David Bosanquet

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Abstract

Introduction
A Below Knee Amputations (BKA) can be undertaken using either a long posterior flap (LPF) or skew flap (SF). Data comparing outcomes between the two are scant.

Objectives
The aim of this study was to compare outcomes between the LPF and SF over a 13-year time period.

Design
Retrospective observational cohort study.

Methods
Consecutive patients undergoing a BKA with the LPF or SF method during a 13-year period at one hospital were identified. Both techniques were performed regularly depending on tissue loss and surgeon preference. The primary outcome was surgical revision of any kind. Secondary outcomes included revision to above knee amputation (AKA), length of hospital stay (LOS) and mortality. A smaller cohort of patients who were alive and unilateral BK amputees were contacted to ascertain prosthetic use and functional status.

Results
242 BKAs were performed in 212 patients (125 LPF and 117 SF; median follow up: 25.8 months). Outcomes for the two groups were equivalent for surgical revision of any kind (LPF: 27 vs SF: 31; p = 0.373), revision to an AKA (LPF: 18 vs SF: 14; p = 0.576), LOS (LPF: 29 days vs SF: 28 days; p = 0.827), and median survival (LPF: 23.9 months vs SF: 28.8 months; p = 0.894). Multivariate analysis found amputation type had no effect on any outcome. Functional scores from a smaller cohort of 40 unilateral amputees who were contactable demonstrated improved outcomes with the LPF compared to the SF (p = 0.038).

Conclusions
Both techniques appear equivalent for rates of surgical residual limb failure. Functional outcomes may be better with the LPF.
Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
DOIs
Publication statusPublished - 24 Apr 2020

Keywords

  • skew flap
  • long posterior flap
  • below knee amputation

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