Above Knee Amputation

Genaral remarks

  • Mostly (75%) performed for ongoing infection, pain and/or necrosis in the lower leg caused by inadequate distal circulation (in the absence of other reconstructive possibilities (e.g. bypass surgery))
  • Other indications include severe trauma and tumors
  • Wound healing may take several weeks, but the emotional adaption can take months
  • Above-knee amputees form the second largest group of all amputees

Step by step

  1. Sterile exposure
  2. Draw a fish mouth shape incision line
  3. Skin incision
  4. Subcutaneous dissection
  5. Opening fascia
  6. Identify and ligate the the large saphenous vein on the medial site of the femur
  7. Dissection of the muscle fibers and therby creating the ventral and dorsal flap
  8. Identify and ligate the large vessels on the posterior side of the femur (femoral artery)
  9. Identify and cut the femoral nerve that also lies posterior to the femur
  10. Shorten the nerve and burry it deep into the muscle to prevent painful post-operative neuroma
  11. Divide the femur
  12. Rasp the femur end
  13. Dissection of the remaining muscle fibers
  14. Closing the fascia with single sutures
  15. Skin closure with single (donati) sutures

  1. The role of different methods of nerve ablation in prevention of neuroma. Chim H1, Miller E, Gliniak C, Cohen ML, Guyuron B. Plast Reconstr Surg. 2013 May;131(5):1004-12