Controversies in lower extremity amputation.

Using the experience gained from taking care of World War II veterans with amputations, Ernest Burgess taught 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. When considering amputation, the physician should establish reasonable goals when confronted with the question of limb salvage versus amputation, understand the roles of the soft-tissue envelope and osseous platform in the creation of a residual limb, understand the method of weight bearing within a prosthetic socket, and determine whether a bone bridge is a positive addition to a transtibial amputation.