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February 7, 1966

The 'How' and the 'Whys' of Immediate Fitting

JAMA. 1966;195(6):39. doi:10.1001/jama.1966.03100060015004

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Why doesn't wound and stump breakdown occur in amputees fitted in the operating room?

The answer is an as yet unclear combination of individual surgical experience and skill, understanding of biomechanics and prosthetic design and, at times, personal confidence.

Even though a relatively limited number of groups have attempted the procedure, each has its own derivations, based on increasing experience, intuition and individual circumstances. The technique described by Dr. Burgess (see pages 37, 38), used in his VA study, is essentially that employed, however.

After amputation level is defined by clinical observation, arteriography, skin temperature and plethysmography determinations, a standard closed flap amputation is done.

An important derivation is that myoplasty is performed and the major muscle groups are sutured through drill holes at the end of the tibia.

A drain, inserted to bone level, is left in as the skin flaps are sutured symmetrically over the stump. A single-layer,

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