Revisiting transtibial amputation with the long posterior flap

Background: The long posterior flap has been the procedure of choice for transtibial amputation for many years, but recently its theoretical basis has been challenged. This study assessed the results with the long posterior flap for leg amputation. Methods: A prospective cohort study was performed. All patients who were referred to the Dundee Limb Fitting Centre for leg amputation between 1987 and 1996 had details of diagnosis, investigations, procedure, and both operative and functional outcome recorded contemporaneously. Results: Some 126 patients required a transfemoral amputation and 445 needed a transtibial procedure. Fifty patients having the transtibial operation, who would otherwise have required a transfemoral amputation, had a medially based flap; the remaining 395 patients underwent a transtibial amputation by the long posterior flap technique. Primary healing was achieved in 317 patients, and 11 amputations healed by secondary intention. Fifty-one patients required a local wedge resection and 16 had a secondary transfemoral amputation. Conclusion: These results compare favourably with those of other published series. The long posterior flap remains to be bettered for routine transtibial amputation.