Amputation

Indications 

1. Significant functional impairment

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30^o

- may need to release  check rein ligaments / accessory collateral ligaments

3. MCPJ contracture >30^o

4. Trigger fingers

- must do limited fasciectomy 

BKA / Below Knee Amputation / Transtibial

Best results

- long posterior musculocutaneous flap 

- well cushioned mobile muscle mass

- full thickness skin

- very anterior scar

Contraindication

- non-ambulator

- get FFD

- better with through knee amputation

Advantages over AKA 

1.  Good Healing