Gritti-Stokes Amputation in the Trauma Patient: Tips and Techniques

[Introduction][1] The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues. [Step 1: Preoperative Planning][2] As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure. [Step 2: Flap Design][3] Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure. ![Figure][4] [Step 3: Soft-Tissue Dissection][5] Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain. ![Figure][4] ![Figure][4] ![Figure][4] [Step 4: Distal Femoral and Patellar Cuts][6] Use a high-speed saw to transect the femur and patella. ![Figure][4] [Step 5: Posterior Dissection][7] Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures. ![Figure][4] ![Figure][4] [Step 6: Patellofemoral Arthrodesis][8] Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture. ![Figure][4] ![Figure][4] [Step 7: Soft-Tissue Closure][9] Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion. ![Figure][4] ![Figure][4] [Step 8: Postoperative Management][10] Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes. [Results][11] The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium. [What to Watch For][12] [Indications][13] [Contraindications][14] [Pitfalls & Challenges][15] [Introduction][1] The Gritti-Stokes amputation establishes osseous continuity between the patella and the distal part of the femur with maintenance of the intact prepatellar soft tissues. [Step 1: Preoperative Planning][2] As with all orthopaedic surgery, preoperative planning is essential to obtaining an optimal outcome with this procedure. [Step 2: Flap Design][3] Use an asymmetric flap consisting of the undisturbed prepatellar soft tissues and rotate it posteriorly to achieve closure. ![Figure][4] [Step 3: Soft-Tissue Dissection][5] Keep soft-tissue dissection subperiosteal or intratendinous to minimize blood loss and postoperative pain. ![Figure][4] ![Figure][4] ![Figure][4] [Step 4: Distal Femoral and Patellar Cuts][6] Use a high-speed saw to transect the femur and patella. ![Figure][4] [Step 5: Posterior Dissection][7] Carry out posterior dissection in a methodical manner, with individual identification and ligation of all neurovascular structures. ![Figure][4] ![Figure][4] [Step 6: Patellofemoral Arthrodesis][8] Suture the patella to the distal part of the femur using six drill holes and nonabsorbable suture. ![Figure][4] ![Figure][4] [Step 7: Soft-Tissue Closure][9] Close the remaining soft tissue, including the posterior musculature, subcutaneous layer, and skin, in a layered fashion. ![Figure][4] ![Figure][4] [Step 8: Postoperative Management][10] Postoperative care should be done in conjunction with a prosthetist to obtain optimal outcomes. [Results][11] The Gritti-Stokes amputation technique appears to be a potentially valuable addition to the amputation surgeon's armamentarium. [What to Watch For][12] [Indications][13] [Contraindications][14] [Pitfalls & Challenges][15] [1]: #sec-12 [2]: #sec-13 [3]: #sec-14 [4]: pending:yes [5]: #sec-15 [6]: #sec-16 [7]: #sec-17 [8]: #sec-18 [9]: #sec-19 [10]: #sec-20 [11]: #sec-21 [12]: #sec-22 [13]: #sec-23 [14]: #sec-24 [15]: #sec-25