Background: A method for closure of a knee
disarticulation wound with use of the posterior calf skin and gastrocnemius
muscle bellies as an integral flap, without destruction of the perforating
vessels, was described by Klaes and Eigler in 1985. The purposes
of the present study were to report our experience with use of this
technique in a prospective series of knee disarticulations and to
determine the healing rate and the functional result after use of the
Methods: Eighty knee disarticulations, performed
with use of the flap described by Klaes and Eigler, in seventy-seven
patients were evaluated in a prospective manner. The patients ranged
in age from nineteen to ninety-two years (mean, sixty-four years).
Thirty-one patients had diabetes mellitus with peripheral vascular
disease, and twenty-nine had peripheral vascular disease alone as
the primary cause of gangrene. Fourteen patients had a traumatic
injury, two had a sarcoma, and one had Ollier disease.
Results: Five patients died in the early postoperative
period, leaving seventy-five stumps available for evaluation. A
total of sixty-seven stumps (89 percent) healed; sixty-three (84
percent) of them healed primarily. Major wound dehiscence occurred
in seven stumps (9 percent), requiring revision to the transfemoral
level. Six of those patients had a serum albumin level of less than
thirty millimoles per liter. Twenty-two (81 percent) of the twenty-seven
patients who could walk before surgery were able to walk with a
prosthesis after it.
Conclusions: This simple technique offers reliable
healing of knee disarticulation wounds in properly selected patients
with a variety of conditions. It also provides comfortable end-bearing
for prosthesis wearers because the distal flap is thick and mobile.