Amputation Stump Preservation and Reconstruction

What are the benefits of amputation stump preservation?

Amputation stumps are most frequently compromised by the development of unstable, ulcerating skin, infection or local pain. These complications can frequently be improved by shortening the amputation stump to reach a zone of better quality tissue. Unfortunately, carrying the amputation to the next level may decrease mobility and make ambulation more difficult. This is well illustrated by comparing the energy expenditure required to walk with a below knee amputation verses an above knee amputation. Walking with a below knee amputation requires a 25% increased energy expenditure over the normal state. The energy expenditure increases to 65% for individuals with above knee amputations. This explains why many elderly patients with associated medical problems cannot ambulate successfully with an above knee prosthesis.

How can amputation stumps be preserved?

Problematic amputation stumps often lack a durable surface that can withstand the sheer forces created by walking with a prosthesis. The situation may be improved by simply improving the fit of the prosthesis, however, local soft tissue enhancement and skin resurfacing is frequently required. Residual muscle can be rearranged to provide extra padding to deficient regions. New skin coverage can be provided in the form of a graft or local flap. When extensive regions require resurfacing then microsurgical techniques are utilized to import healthy skin and fat from regions of excess elsewhere on the body (free flap). If bony elongation would prove beneficial then vascularized bone flaps or bone stretch utilizing the Ilizarov device can be employed. Sometimes, local pain resulting from excessive nerve scarring (neuroma) may be the source of amputation stump dysfunction. In this situation, the damaged nerve segment is removed and the nerve repositioned into a protective pocket of muscle.