Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XXI: Amputations
United States Department of Defense
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The level of amputation is determined by the nature and extent of the injury. Amputations should be performed at the lowest possible level of viable tissues. All viable skin and soft tissues distal to the indicated level of bone amputations should be preserved for use in subsequent closure of the amputation stump. This is especially true for amputations below the knee, in which short tibial stumps can be saved with posteriorly-based flaps. Surgical principles concerning the construction and dimensions of viable flaps should be tailored to the specific need for each patient. To save length, any shape or form of a viable flap should be used.
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