Transfemoral Amputation

Transfemoral Amputation or above-knee amputation is a procedure performed to remove the injured limb that results primarily from traumatic events, cancer, or vascular disease.

See Also: Syme Amputation & Prosthesis

Transfemoral Amputation Procedure Steps

• Position the patient supine on the operating table, and perform the surgery using tourniquet hemostasis.
• Beginning proximally at the anticipated level of bone section, outline equal anterior and posterior skin flaps. The length of each flap should be at least one half the anteroposterior diameter of the thigh at this level. Atypical flaps always are preferred to amputation at a higher level.
• Fashion the anterior flap with an incision that starts at the midpoint on the medial aspect of the thigh at the level of anticipated bone section. The incision passes in a gentle curve distally and laterally, crosses the anterior aspect of the thigh at the level determined as noted earlier, and curves proximally to end on the lateral aspect of the thigh opposite the starting point
• Fashion the posterior flap in a similar manner
• Deepen the skin incisions through the subcutaneous tissue and deep fascia, and reflect the flaps proximally to the level of bone section.
• Divide the quadriceps muscle and its overlying fascia along the line of the anterior incision, and reflect it proximally to the level of intended bone section as a myofascial flap.
• Identify, individually ligate, and transect the femoral artery and vein in the femoral canal on the medial side of the thigh at the level of bone section. Incise the periosteum of the femur circumferentially, and divide the bone with a saw immediately distal to the periosteal incision.
• With a sharp rasp, smooth the edges of the bone, and flatten the anterolateral aspect of the femur to decrease the unit pressures between the bone and the overlying soft tissues.
• Identify the sciatic nerve just beneath the hamstring muscles, ligate it well proximal to the end of the bone, and divide it just distal to the ligature.
• Divide the posterior muscles transversely so that their ends retract to the level of bone section, and remove the leg
• Isolate and section all cutaneous nerves so that their cut ends retract well proximal to the end of the stump. Irrigate the wound with saline to remove all bone dust.
• Through several small holes drilled just proximal to the end of the femur, attach the adductor and hamstring muscles to the bone with nonabsorbable or absorbable sutures. The muscles should be attached under slight tension.
• At this point, release the tourniquet and attain meticulous hemostasis.
• Bring the “quadriceps apron” over the end of the bone, and suture its fascial layer to the posterior fascia of the thigh, trimming any excess muscle or fascia to permit a neat, snug approximation.
• Insert plastic suction drainage tubes beneath the muscle flap and deep fascia, and bring them out through the lateral aspect of the thigh 10 to 12.5 cm proximal to the end of the stump.
• Approximate the skin edges with interrupted sutures of nonabsorbable material.

References & More

1. Campbel’s Operative Orthopaedics 12th edition Book.
2. Bell JC, Wolf EJ, Schnall BL, Tis JE, Potter BK. Transfemoral amputations: is there an effect of residual limb length and orientation on energy expenditure? Clin Orthop Relat Res. 2014 Oct;472(10):3055-61. doi: 10.1007/s11999-014-3630-x. PMID: 24752912; PMCID: PMC4160504. Pubmed
3. Bell JC, Wolf EJ, Schnall BL, Tis JE, Tis LL, Benjamin KPM. Transfemoral amputations: the effect of residual limb length and orientation on gait analysis outcome measures. J Bone Joint Surg Am. 2013;95:408–414. doi: 10.2106/JBJS.K.01446. PubMed