Abstract
The previous two chapters have described a series of surgical procedures that illustrate priorities in the management of limb-threatening injury and disease. Failing prevention or successful nonoperative management, the surgeon
selects a level of amputation that minimizes tissue loss, enables healing, and preserves as much function as possible.
Walking will almost always still be possible if only the forefoot is lost. The functionality of mid- and hind-foot amputations is highly variable, but may suffice for younger healthier
patients. If no part of the foot can be salvaged, the surgeon
will then typically be faced with a decision that has major
consequences for the patient: whether to attempt salvage of
the knee joint.
As previously emphasized, loss of the knee joint markedly
reduces the chance of community ambulation in all but the
heartiest and most motivated patients. Yet all amputation
surgeons are familiar with the circumstances that render the
leg and knee unsalvageable: severe ischemia, infection, joint
contractures, crush injuries, or other extensive trauma. The
current chapter will address techniques that again give priority to healing and function, even when the knee joint cannot be preserved.