Choice of level of amputation

The level of amputation should be carefully considered to ensure that there is sufficient perfusion to achieve wound healing. When possible, a below-knee amputation should be carried out to conserve the knee joint and aid the fitting of a prosthesis. Preserving the knee joint lowers the energy expenditure necessary for walking. The cardiovascular cost for walking and foot plantar pressures in the opposite limb both increase in direct proportion as the amputation becomes more proximal. The aims are:

• To keep the amputation as distal as possible

• To amputate above painful, cold, pale discoloured tissue

• To amputate below warm pink well-perfused tissue. About one-fifth of transtibial amputations and knee disarticulation amputations undergo revision surgery to proximal amputation due to healing complications.

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