A new surgical-prosthetic approach to the Syme's amputation, a preliminary report.

The advantage of the end-bearing ankledisarticulation amputation has been well recognized since Syme published his classic article in 1843 (2). Disadvantages and complications of this level of amputation have led some surgeons to favor amputation at a higher level. Failure of adherence of the heel pad to the distal tibia, resulting in a flabby, loose stump, prevents many amputees from ambulating without a prosthesis (Fig. 1) (1). Breakdown of the stump is a frequent occurrence. The appearance of the conventional Syme prosthesis is objectionable to many amputees, particularly females, because of its bulbous end. Within recent years, the introduction of the plastic Syme prosthesis in which a portion of the weight of the amputee is borne by the patellar tendon has resulted in greater acceptance of this level of amputation (J). However, the conventional plastic Syme prosthesis still retains a wider distal end and a window for the accommodation of the bulbous stump, significant disadvantages in appearance and structure. To overcome the objectionable features of the Syme's amputation, there has been developed at Jackson Memorial Hospital, University of Miami School of Medicine, a new surgicalprosthetic approach to this amputation which maintains the end-bearing quality of the stump and improves upon the appearance of the prosthesis.