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Review
. 2024 Apr 4;9(4):276-284.
doi: 10.1530/EOR-23-0118.

Modified Gritti-Stokes amputation: tips and tricks

Laura Walthert  1 , Michael Ris  1 , Kevin Moerenhout  1 , Sébastien Déglise  2 , Pietro Giovanni Di Summa  3 , Sylvain Steinmetz  1
Affiliations
Review

Modified Gritti-Stokes amputation: tips and tricks

Laura Walthert et al. EFORT Open Rev. .

Abstract

Major amputations of the lower extremity may be required after trauma and a variety of underlying diseases such as peripheral vascular disease, diabetes, and malignancies. The goal of any major amputation is an optimal functional result with a maximum limb length in combination with optimal wound healing. The preservation of the knee joint is essential for successful rehabilitation, and this is best achieved by the Burgess below-knee amputation (BKA). Whenever a BKA is not possible, the Gritti-Stokes amputation is our first choice. This technique mainly consists of a through-knee amputation with the creation of a pedicled patella flap consisting of the patella, patellar ligament, and overlying soft tissue. After osteotomy of the distal femur and resection of the articular surface of the patella, the anterior flap is rotated in order to cover the femur defect while performing a patellofemoral arthrodesis. The aim of this paper is to describe our surgical technique and experience with GSA and to point out the important steps of this procedure. In conclusion, GSA is an excellent surgical option for patients requiring major lower limb amputations where BKA cannot be considered. Particular attention must be paid to careful preoperative evaluation and optimization of comorbidities. A meticulous surgical technique is warranted, including atraumatic tissue handling and an optimal patellofemoral arthrodesis technique.

Keywords: Gritti–Stokes; amputation; lower limb; trans-knee amputation.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the study reported.

Figures

Figure 1
Figure 1
Skin incision, medial.
Figure 2
Figure 2
Skin incision, anterior.
Figure 3
Figure 3
Skin incision, lateral.
Figure 4
Figure 4
Skin incision, front.
Figure 5
Figure 5
Skin incision, profile.
Figure 6
Figure 6
Soft tissue incision and exposure of the knee joint.
Figure 7
Figure 7
Femoral and patellar bone cut for the modified Gritti–Stokes amputation.
Figure 8
Figure 8
Suture of a femoropatellar arthrodesis in a modified Gritti–Stokes amputation.
Figure 9
Figure 9
Gritti–Stokes amputation: femoropatellar arthrodesis.
Figure 10
Figure 10
Modified Gritti–Stokes amputation after skin closure.
Figure 11
Figure 11
Postoperative X-ray image femur AP after modified Gritti–Stokes amputation.
Figure 12
Figure 12
Postoperative X-ray image femur profile after modified Gritti–Stokes amputation.
See this image and copyright information in PMC

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References

    1. Faber DC & Fielding LP. Gritti-Stokes (through-knee) amputation: should it be reintroduced? (through-knee). Southern Medical Journal 200194997–1001. - PubMed
    1. Houghton A Allen A Luff R & McColl I. Rehabilitation after lower limb amputation: a comparative study of above-knee, through-knee and Gritti-Stokes amputations. British Journal of Surgery 198976622–624. (10.1002/bjs.1800760633) - DOI - PubMed
    1. Beacock CJ Doran J Hopkinson BR & Makin GS. A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease. Annals of the Royal College of Surgeons of England 19836590–92. - PMC - PubMed
    1. Baumgartner R. Transtibial amputation. Operative Orthopädie und Traumatologie 201123280–288. (10.1007/s00064-011-0040-z) - DOI - PubMed
    1. Pinzur MS Stuck R Sage R & Osterman H. Transcutaneous oxygen tension in the dysvascular foot with infection. Foot and Ankle 199314254–256. (10.1177/107110079301400503) - DOI - PubMed

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