The Below-knee Amputation "

rhroughout the United States and Canada an estimated 80 percent of all major elective civilian amputations result from ischemia. All but a relatively few involve the lower extremity. Significant improvements in below-knee prostheses and important advances in surgical and postsurgical management now allow amputation below the knee in a majority of patients. In a consecutive series of 96 unselected major lower-extremity amputations for peripheral vascular disease1964 to 1967-we have been able to obtain primary healing at the below-knee level in 75 percent of the cases. Once healed, the stumps remain healed. With adequate prosthetic care, secondary breakdown will seldom occur. I t is not possible to overestimate the great importance of the knee in amputee rehabilitation. This is true especially in the older, classical, ischemic patient. Debility, impaired vision and balance, neuropathy, compromised circulation and function in the remaining lower limb, together with chronic systemic illness, all emphasize the critical need to save the knee. The older bilateral leg amputee especially needs his knees to approach the rehabilitation goal permitting a reasonable degree of ambulation and self sufficiency. The below-knee amputation thus becomes statistically by far the most important major elective technique.