08/05/2026
🦿 Below Knee Amputation (BKA) with Skew Flap
In cases of non-salvageable distal limb, the goal is not just amputation but the creation of a functional, durable stump suitable for early prosthetic rehabilitation.
🔹 Why BKA?
Preserves the knee joint → better mobility, balance, and energy efficiency with prosthesis.
🔹 Skew flap technique:
An asymmetric flap design tailored to available healthy tissue, allowing:
• Adequate soft-tissue coverage of the tibial stump
• Better padding over pressure-bearing areas
• Tension-free closure in compromised wounds
🔹 Key surgical principles:
• Tibial beveling to reduce pressure points
• Myodesis/myoplasty for muscle stabilization
• Preservation of vascularized tissue for healing
• Stump shaping for prosthetic fitting
🧠 Teaching point:
A well-constructed BKA stump directly determines prosthetic comfort, gait efficiency, and long-term function. Flap choice should always be individualized based on tissue viability.
Reconstruction sometimes means preparing for the next step — walking again with a prosthesis.
