BKA, also known as Below-Knee Amputation is an amputation procedure that involves the removal of the foot, ankle joint, fibula and shank bone and all the damaged soft tissues in that area. BKA Stump revision is the procedure done after the first amputation of the lower limb as a result of disease, trauma or surgery.

AKA, also known as Above-Knee Amputation involves amputation that is performed at the thigh level on the femoral bone.

Stump revision for both BKA and AKA is done when the prosthesis installed previously has become uncomfortable due to its fitting or weight. This is normally done months or years later after the wound has healed. The goal of the stump revision is to ensure the stump is intact for a longer period and the soft tissue recovers well to cover the stump.

Indications of a Stump Revision

There are various factors that can lead to a stump revision. These include:

• Infection that has occurred after the initial amputation
• Pseudospherical pain (Phantom limb pain which is still felt where the leg was amputated)
• Inflammation that causes bone spurs (outgrowth of the bone that occur near the tendons or cartilage)
• Stump prosthetic that needs improvement of its fitting
• Skin graft which has delayed in healing that needs revision to preserve the length of the stump.
• Neuroma, which pain on the scar linked to the bone

Techniques Involved in Stump Revision

There a number of surgical procedures that are performed to repair BKA and AKA stump defects, done under anesthesia at the lower spinal segment. When the soft tissues coverage has not healed as desired, this leads to scarring, ulcers and excess soft tissue growth. For this, plastic and reconstructive procedures are performed to repair it. These include:

Distortion procedure:  This is done to pull and push the scar when the damage in the soft tissues tends to be larger and out-covers the healthy skin. The surrounding healthy skin is pulled and pushed by implanting balloon dilators under the scar to stretch the healthy skin.

The surgery is implemented when the skin has stretched to efficiently cover the damage. Stamp skin grafting is however not considered often due to its wear appeal, which may cause rapture after a prosthesis is installed.

Resection of the tissues: This is done with a sharp incision and nerve end intersection. The nerve end is then inserted with epineurium (the thick case of connective tissue that surrounds the torso of a nerve). This resection is performed to remove the stump bone spur as the bone is filed to form a smooth round contour. If the stump has formed a cone-shape or funnel shape, myoplasty technique is used to stitch a muscle to another muscle, which is then placed at the end of the bone that has been shortened to form a cylindrical limb.

Osteoplastic procedure: This technique is performed when the residual of the lower leg has a long protruding fibula. It is done by shortening the fibula then roughening it using a bone chisel at the opposite side of the tibia and fibula to form a scaly surface. Iliac bone is grafted for autogenous bone graft and then fixed as a bone bridge.

Debridement and suction-irrigation drainage: This is done for a deep sternal wound infection in the residual limb. It is performed with the use of a plaster of Paris splint and elastic bandage to enhance assimilation of the stump swelling and prevent the joint from bending (flexion contracture).

In cases whereby the above surgical procedures do not resolve the stump problems, a revision amputation is then recommended.

Possible Complications of a Stump Revision

Some of the complications that may be presented after a stump revision are mainly the hinderance of the fitting of the prosthetic and weight-bearing. Others include:

• Scarring of the stump or ulcers on the area
• Excess formation of soft tissues
• Delay in healing of the wound
• Phantom limb pain

Post-op Guidelines

After the stump revision procedure, you are required to elevate the stump for 1-2 days then reposition by turning and moving slowly from side to side to avoid generating muscle spasms and hip contractures.

Get in Touch

Reconstructive surgery at Kings College Hospital Dubai focuses on the safety and care of every patient in a compassionate environment with state-of-the-art facilities. To book an online or in-person consultation and a detailed evaluation by one of our world class plastic and reconstructive surgeons in Dubai, get in touch using the contact details given, and our patient-care staff will book an appointment for you.