Transtibial amputations (TTAs) have traditionally been surgically bevelled at the anterior tibia by a surgical saw. Furthermore, the fibula has been cut shorter than the distal tibia by 2 to 3 cm. It is thought that these two measures result in quicker wound healing by virtue of less of a “pressure point” irritating the soft tissue from sharp, bony angles.
In our rehabilitation practice of a largely dysvascular population, most TTAs presenting for prosthetic fitting and gait retraining at a rehabilitation hospital had the tibia bevelled and fibula shortened. However, a large number did not. It was our impression that the patients who had these measures taken had quicker healing of the surgical incision than those who did not. A review of the literature from 1965 to the present revealed that the issue has never been formally studied. There are only clinical impressions of various authors stating that, in their experience, it is better to bevel the tibia and shorten the fibula.
We have reviewed the radiographs and charts of 142 TTAs admitted to a rehabilitation facility between January of 1993 and December of 1995. We categorized the patients according to the types of surgical bone cuts and correlated them with the time from the date of surgery to the point of healing (as estimated by the date of first prosthetic fitting). Our results show that shortening the fibula at the time of TTA correlates with a shorter time to heal the wound (p = .046), but bevelling of the tibia is of questionable value in the dysvascular patient (p = .91).
NORA CULLEN, MD, MSc, FRCPC is an assistant professor with the Division of Physiatry, University of Toronto and Toronto Rehabilitation Institute, Toronto, ON.
MICHAEL DEVLIN, MD, FRCPC is an assistant professor with the Division of Physiatry, University of Toronto and West Park Hospital.
Nora Cullen, MD, FRCPC, Toronto Rehabilitation Institute, 550 University Avenue, Room 1113, Toronto, ON, M4G 2A2. E-mail: cullen.nora@TorontoRehab.on.ca
© 2000 American Academy of Orthotists & Prosthetists