The Burgess Long Posterior Flap Below Knee Amputation

Note the gangrenous area of the left leg extending up to distal third of the lower limb. There is also present of macerated area over the left leg due to pressure from immobilize limb. This patient was subjected to BKA after failed re vascularization surgery using the long saphenous vein after involving in motor vehicle accident

1) Usual site for below knee amputation is 14 cm below the joint line or 10-12 com below the tibial tuberosity



2) Minimum level permitted for successful limb fitting is 7 cm below the joint line

3) Skin flap is marked using length of suture materials and skin marker with the usage of rule of third

Image source:Colette Marshall & Gerry Stansby

4) Skin incision place 1 cm distal to the proposed level of tibal transection

5) Skin and subcutaneous tissue are incised with scalpel.

6) Muscle of anterior and posterior compartment is cut with diathermy blade

7) Vessels are identified, divided and ligated with absordable suture materials.

8) Tibial nerve is divided under gentle traction with scalpel blade. Identify and diathermize the vasa nervarum to avoid troublesome bleeding in the depth of wound

9) Fibula is stripped of periosteum up to 2 cm above skin incision


10) Strip the tibia at the level of planned division

The bone is stripped with the chain saw

11) Cut the soleus muscle with the level of bone section and exclude from posterior flap

12) Thinned the gastrocnemius muscle enough for tibial bone end coverage.

13) Secure the hemostasis and insert drain before closure.

14) Fascia is brought together with interrupted sutures and the skin is closed


Reference: Colette Marshall & Gerry Stansby, "Amputation", Surgery 26:1, Elsevier, 2007