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Selected Instructional Course Lecture   |    
Controversies in Lower-Extremity Amputation
Michael S. Pinzur, MD1; Frank A. Gottschalk, MD2; Marco Antonio Guedes de S. Pinto, MD3; Douglas G. Smith, MD4
1 Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153. E-mail address: mpinzu1@lumc.edu
2 Department of Orthopaedic Surgery, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390
3 Centro Marian Weiss, Rua Mourato Coelho 1417, Vila Madalena 05417-012, Sao Paulo, Brazil
4 Department of Orthopaedic Surgery, University of Washington Medical Center, Harborview Medical Center, 325 9th Avenue, Box 359798, Seattle, WA 98104
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Otto Bock. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2008 in Instructional Course Lectures, Volume 57. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 May 01;89(5):1118-1127
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Extract

Using the experience gained from taking care of World War II veterans with amputations, Ernest Burgess taught us that amputation surgery is reconstructive surgery. It is the first step in the rehabilitation process for patients with an amputation and should be thought of in this way. An amputation is often a more appropriate option than limb salvage, irrespective of the underlying cause. The decision-making and selection of the amputation level must be based on realistic expectations with regard to functional outcome and must be adapted to both the disease process being treated and the unique needs of the patient. Sometimes the amputation is done as a life-saving procedure in a patient who is not expected to walk, but more often it is done for a patient who should be able to return to a full active life. This lecture addresses amputations done to return the patient to full activity. Our purposes are to assist the reader in (1) establishing reasonable goals when confronted with the question of limb salvage versus amputation, (2) understanding the roles of the soft-tissue envelope and osseous platform in the creation of a residual limb, (3) understanding the method of weight-bearing within a prosthetic socket, and (4) determining whether a bone bridge is a positive addition to a transtibial amputation.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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