After removal of the leg, folding the flap forward and applying pressure can control bleeding. The lateral portions of the gastrocnemius muscle bellies are trimmed and the soleus muscle is removed. The actual myoplasty refers to the suture of the divided muscle end taking care that the agonist and antagonist are stitched over the divided bone end. Another commonly mentioned procedure is known as the Skew flap technique. The flaps are separate from the gastrocnemius and soleus muscles which are used to cover the tibial stump.
Postoperative dressing is rigid plaster of paris cast.
The factors affecting the outcome in terms of healing include those directly related to the local blood supply. Patients with palpable popliteal pulses, and those with diabetes showed a tendency to quicker healing. Clinically detected myocardial disease significantly predisposes poor outcome. Patients whom undergo previous vascular surgery will tend to have a better outcome. High haematocrit indicates a greater likelihood of re-amputation.