Below-Knee Amputation for Ischaemic Gangrene:Prospective, Randomized Comparison of a Transverse and a Sagittal Operative Technique

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Abstract
In a prospective, randomized study of primary below-knee amputation for ischemic gangrene, a comparison was made in the results obtained by 2 methods of amputation. In 47 cases a transverse technique with a long posterior musculo-cutaneous flap and in 41 cases a sagittal technique with equally long medial and lateral musculo-cutaneous flaps was used. Both operations were followed by 2 wk in a half-open plaster cast with knee extended. The sex ratio and age distribution were the same in both groups. The vascular condition in the 2 groups showed minor differences, assessed by the duration of rest pain, pulsation findings, extent of gangrene, and frequency of diabetes, wholly or partially equalized each other. Healing course was the same in both groups, primary healing occurring in 38 and 41%, respectively. There were no differences between the groups with respect to limb fitting, ambulation, occupational or social status. The choice of operation can be based merely upon surgical skill and the ischemic changes in the lower leg.

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