Transtibiale

Transtibiale, commonly referred to as a below-knee amputation (BKA), is a surgical procedure that removes the lower leg through the tibia and fibula below the knee joint. The knee is preserved, which can improve rehabilitation potential and functional gait compared with higher-level amputations. The residual limb length and soft tissue coverage influence prosthetic fitting and outcomes.

Indications for a transtibial amputation include severe traumatic injury with non-salvageable tissue, extensive infection or osteomyelitis, malignant tumors of the bone or soft tissue, and non-reconstructible vascular disease or diabetic ischemia leading to non-healing ulcers. Preoperative planning aims to maximize tibial length while ensuring reliable soft tissue coverage to facilitate a well-fitting prosthesis and to minimize neuroma formation.

Surgical technique typically involves removing the distal limb while shaping the remaining stump with a myocutaneous flap to provide stable soft tissue coverage. Nerves are managed to reduce painful neuromas, and meticulous hemostasis and edema control are important. Postoperative care includes wound assessment, stump shaping, compression wrapping, and early mobilization to prevent knee stiffness and improve overall rehabilitation potential.

Rehabilitation focuses on stump conditioning, range of motion, and strengthening, followed by prosthetic fitting and gait training. Modern prostheses enable a wide range of activities and often restore substantial walking ability, though outcomes depend on residual limb length, overall health, and comorbidities. Common complications include wound-healing problems, infection, phantom limb pain, neuroma formation, edema, and contractures if positioning and therapy are not optimized.