Authors: (Daniel C. Allison, Elke R. Ahlmann, Greg Restivo, Anny H. Xiang, Lawrence R. Menendez, Division of Musculoskeletal Oncology, Southern California Permanente Medical Group, Department of Orthopedics, University of Southern California, Baldwin Park, California, USA, and others)
Abstract: After reviewing new innovations in amputation, specifically bone anchored prostheses, we describe our experience with a new surgical dissection technique in above knee amputations. Although the technique of osseointegrated prostheses is relatively new and the results of larger clinical trials are still pending review, the concept represents a promising development in the rehabilitation of individuals with transfemoral (and potentially other forms of) amputation, resulting in improved ambulation and comfort, decreased skin problems, and an overall increase in quality of life. Furthermore, in regard to surgical dissection during amputation, muscle transection through standard electrocautery can be time consuming and bloody. Therefore, we compared electrocautery to the linear cutting stapling device (LCS) in the setting of above knee amputation (AKA) to see if the LCS decreases surgical time, blood loss, transfusion rates, and complications. Through retrospective review of AKA cases over a 10-year period, cases performed using electrocautery were compared to cases performed with the LCS. At a mean follow up of 45.3 months, the 11 LCS cases had decreased mean blood loss (302cc versus 510cc), decreased mean transfusion rates (1.55 units versus 2.15 units), and decreased mean surgical time (97min. versus 119min.) when compared to the 13 electrocautery cases. The differences in blood loss and surgical time trended toward, but did not achieve, statistical significance. Complications and revision surgeries were similar between the two groups. In skeletal muscle transection, the linear cutting stapler is a viable and cost effective technical alternative to electrocautery, likely resulting in less blood loss and shorter surgical time, with similar rates of complications.