A 55-year-old diabetic with peripheral arterial disease undergoes a below-knee amputation. The surgical technique that preserves the long posterior flap (Burgess technique) is preferred over equal flaps. The rationale for using the long posterior flap is:

• A Gastrocnemius-soleus bulk provides better prosthetic cushioning over the tibial remnant
• B It allows a longer tibial remnant for better prosthetic leverage
• C The posterior skin has less neuropathic involvement, reducing wound complications
• D The posterior compartment has superior blood supply in ischemic limbs, ensuring flap viability ✓

Explanation

The Burgess long posterior flap technique for below-knee (transtibial) amputation relies on the principle that the posterior compartment of the leg (posterior tibial and peroneal artery territory) has better perfusion than the anterior compartment in the presence of peripheral arterial disease. The calf musculature (gastrocnemius-soleus) attached to the posterior flap is well-vascularized even when anterior tibial territory is ischemic, ensuring reliable flap healing and avoiding wound breakdown. It also provides good soft tissue cushioning over the distal tibia.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.