Above Knee Amputation

A. Fathi
 Above-knee amputations
may be performed through
The distal femur
(supracondylar)
The midfemur (diaphyseal),
or
Just below the lesser
trochanter (high above-knee
amputation)
Tumors of the distal femur
high above-knee
amputation
Tumors of the leg
standard above-knee
amputation
 SURGICAL TECHNIQUE
The patient is supine,
and the operated
extremity should be
abducted and flexed
The most common
type of flap is the
anterior and posterior
fish-mouth flap
The skin incision
should be planned
accordingly
 Transect the quadriceps musculature anteriorly;
this will leave the muscle even with the level of
bone transection.
Next, either cut the femur (as this permits the
transection of tissues from anterior to posterior)
or complete the soft-tissue work prior to cutting
the bone. Cut the adductors and hamstrings so
that they also lie even with the cut bone.
 Obtain hemostasis
and isolate and
doubly ligate the
large vessels with at
least one suture
ligature. Place a
ligature on the sciatic
nerve well above the
level of amputation,
prior to sharply
transecting the nerve.
Fashion the muscle flaps
and do a myoplasty by
approximating the
anterior to the posterior
myofascial flap. In
younger active patients,
place two drill holes in the
bony stump end for each
compartment, and do a
myodesis by pulling the
muscles out to length and
securing them to the bone
end with sutures. This
improves the power and
control over the stump
and keeps the bone
centralized in the stump.
 Place a drain and
close the
subcutaneous
flap and skin
loosely with
interrupted
sutures or
staples.
 Sumber
Chapman's Orthopaedic Surgery, 3rd
Edition. 2001. Lippincott Williams &
Wilkins
Paul Sugarbaker, Jacob Bickels and
Martin Malawer. Above-knee
Amputation
 Sciatic and Femoral Nerves
The cut ends of the
nerves may form
neuromata, which can
be extremely painful
when exposed to
pressure from the
prosthesis or direct
trauma. Therefore, the
nerve endings must be
positioned, and even