Burgess technique vs Modified Bruckner Procedure in below knee Amputation -A Prospective Randomised Control Study

Below knee amputation is most commonly performed in peripheral vascular disease and diabetes mellitus and in more than 50% of the cases diabetic foot infection forms the sole indication of lower limb amputation. Long posterior flap technique of burgess for below knee amputation has been commonly used since 1960s, modification of long posterior flap technique of burgess, medial-lateral sagittal flap technique, medial dominant sagittal flap technique also exist in the literature. However, none of these techniques have proven to be superior to long posterior flap technique of burgess. But in the burgess technique, assessment of viability of the crural muscles relies upon the experience of the surgeon, thus problems of wound healing and secondary procedures due to muscle necrosis are frequently encountered. Because of these disadvantages, lutz Bruckner has modified the burgess technique and described his own modification where muscles of anterior and lateral compartments, together with the soleus muscle and if necessary the fibula, are removed to avoid secondary procedures due to muscle necrosis and tension in the stump. In this study, in this study we will study about the outcomes of Burgess technique vs modified Bruckner procedure. Materials and Methods: This study comprises of population of 50 patients admitted who has underwent Below Knee amputation in Kanyakumari Government Medical College Hospital. The patients enrolled for the study will be randomly categorised in to two groups with one group undergoing burgess technique and other modified Bruckner technique. Informed written consent will be obtained from all patients. The primary outcomes such wound infection, flap necrosis, need for revision surgery, length of hospital stay, functional rehabilitation will be compared in these techniques. Results: In this study, the mean age of the patient is 67.2(38-71) in 32 males and 28 females. Stump revision is needed in 4 patients (17.1%) who underwent burgess technique and in only one patient who underwent modified Bruckner technique. Flap necrosis was seen in 47% of patients in burgess technique and of 16% in modified Bruckner technique. The average length of hospital stay is 21.5 days and 14.96 days in burgess and Bruckner technique respectively. Mortality is seen in 12% and 4% in burgess and Bruckner technique respectively. Conclusion: Individuals having below-knee amputation utilising either of the two processes in this study demonstrated that those using the modified Bruckner approach had a higher rate of primary wound healing and a better outcome than those using the regular Burgess technique.