Kaufman J L
Division of Vascular Surgery, Baystate Medical Center, Springfield, MA 01199, USA.
J Am Coll Surg. 1995 Dec;181(6):511-6.
In 1956, Kendrick described a technique for below-knee amputation (BKA) using anterior and posterior flaps in a length ratio of 1:2. There has been no review of the utility and safety of this technique over the past four decades.
The Kendrick method was studied in 96 consecutive patients who underwent 100 BKAs from 1982 to 1995. Follow-up examination was continued through the period of rehabilitation and included all revisional surgery.
Eighty-one patients had diabetes mellitus, 15 patients were nondiabetic, and the mean age was 67 years (range, 12 to 94 years). Fifty-seven patients underwent BKA for diabetic foot sepsis with healing failure after debridement or nonreconstructable vascular disease, 19 patients underwent BKAs for progressive necrosis despite a patent arterial reconstruction, and 24 patients underwent BKAs for other causes, including microembolism, calciphylaxis-related gangrene, bypass failure, trauma, frostbite, and calf-wound healing failure after coronary revascularization. Preliminary guillotine amputations were performed on three limbs. There was an incision in the calf from previous vascular surgery in 25 limbs. The 30-day mortality rate was 6 percent. Healing of the stump and knee salvage occurred in 93 limbs (93 percent). Four patients had local wound complications develop in the stump, yet they eventually healed. During the follow-up period, conversion to an above-knee amputation was necessary in seven patients, five within 30 days. Only one of these was in a limb with a previous arterial reconstruction in the calf.
The Kendrick procedure for BKA with anterior and posterior flaps is efficacious and safe. This procedure is advantageous for its anatomic basis, the ease with which the flaps can be designed despite leg edema or overall size, and the ability of the surgeon to distance the posterior flap margin from sepsis in the lower one-third of the calf.
1956年，肯德里克描述了一种使用前后皮瓣、长度比例为1:2的膝下截肢（BKA）技术。在过去的四十年里，尚未对该技术的实用性和安全性进行过综述。
对1982年至1995年间连续96例接受100次BKA手术的患者采用肯德里克方法进行研究。随访检查持续至康复期，并包括所有翻修手术。
81例患者患有糖尿病，15例患者无糖尿病，平均年龄为67岁（范围为12至94岁）。57例患者因糖尿病足败血症在清创后愈合失败或血管疾病无法重建而接受BKA手术，19例患者尽管动脉重建通畅但仍因进行性坏死接受BKA手术，24例患者因其他原因接受BKA手术，包括微栓塞、钙化防御相关坏疽、旁路失败、创伤、冻伤以及冠状动脉血运重建后小腿伤口愈合失败。对三条肢体进行了初步的断头截肢术。25条肢体因先前的血管手术在小腿有切口。30天死亡率为6%。93条肢体（93%）残端愈合且膝关节得以保留。4例患者残端出现局部伤口并发症，但最终愈合。在随访期间，7例患者需要转为膝上截肢，其中5例在30天内。这些患者中只有1例小腿先前有动脉重建。
采用前后皮瓣的肯德里克BKA手术方法有效且安全。该手术因其解剖学基础、无论腿部水肿或整体大小均可轻松设计皮瓣以及外科医生能够使后皮瓣边缘远离小腿下三分之一处的感染而具有优势。
