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Below the knee amputation is a surgery performed by removal of the lower leg below the knee joint. Before surgery, patient is given general anesthesia. The area scheduled to be operated on, is shaved, scrubbed with soap and antiseptic, and draped so that only the area of incision is exposed. The surgeon makes the incisions in the skin, fascia, muscles, and fat that will allow him to form a covering for the stump. Bleeding vessels are ligated as they are encountered. When the tissue flaps are prepared and the bone is exposed, it is sawn down through and filled smooth. During the below the knee amputation, bone wax is also used to stop bleeding if necessary. The stump is constructed from surrounding flaps of tissue, and the fascia, skin, and muscle are closed in layers, with careful attention paid to preserving a good blood supply to the stump. The individual is transferred to the recovery room and the surgeon may choose to use a pylon arrangement and plaster cast, a metal rod that extends from the bottom of the cast to the artificial foot, to aid in early return to walking. It takes about one year to reach maximum improvement in general functioning and walking. If the stump proves to be too short for normal walking, a soviet-developed limb-stretching technique called the “Ilizarov extension” may be used to lengthen it.
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