{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:18:41Z","timestamp":1784557121908,"version":"3.55.0"},"reference-count":22,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["eor.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:p>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Major amputations of the lower extremity may be required after trauma and a variety of underlying diseases such as peripheral vascular disease, diabetes, and malignancies.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The goal of any major amputation is an optimal functional result with a maximum limb length in combination with optimal wound healing. The preservation of the knee joint is essential for successful rehabilitation, and this is best achieved by the Burgess below-knee amputation (BKA).<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Whenever a BKA is not possible, the Gritti\u2013Stokes amputation is our first choice.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>This technique mainly consists of a through-knee amputation with the creation of a pedicled patella flap consisting of the patella, patellar ligament, and overlying soft tissue. After osteotomy of the distal femur and resection of the articular surface of the patella, the anterior flap is rotated in order to cover the femur defect while performing a patellofemoral arthrodesis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The aim of this paper is to describe our surgical technique and experience with GSA and to point out the important steps of this procedure.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>In conclusion, GSA is an excellent surgical option for patients requiring major lower limb amputations where BKA cannot be considered. Particular attention must be paid to careful preoperative evaluation and optimization of comorbidities. A meticulous surgical technique is warranted, including atraumatic tissue handling and an optimal patellofemoral arthrodesis technique.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.1530\/eor-23-0118","type":"journal-article","created":{"date-parts":[[2024,4,4]],"date-time":"2024-04-04T08:30:57Z","timestamp":1712219457000},"page":"276-284","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":1,"title":["Modified Gritti\u2013Stokes amputation: tips and tricks"],"prefix":"10.1530","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3940-7361","authenticated-orcid":true,"given":"Laura","family":"Walthert","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ris","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Moerenhout","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"D\u00e9glise","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro Giovanni","family":"Di Summa","sequence":"additional","affiliation":[{"name":"Department of Plastic and Hand Surgery, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Southern Medical Journal","first-page":"997","article-title":"Gritti-Stokes (through-knee) amputation: should it be reintroduced?","volume":"94","author":"Faber","year":"2001","unstructured":"Faber DC & Fielding LP. Gritti-Stokes (through-knee) amputation: should it be reintroduced? (through-knee). Southern Medical Journal200194997\u20131001."},{"key":"bib2","series-title":"British Journal of Surgery","first-page":"622","article-title":"Rehabilitation after lower limb amputation: a comparative study of above-knee, through-knee and Gritti-Stokes amputations","volume":"76","author":"Houghton","year":"1989","unstructured":"Houghton AAllen ALuff R & McColl I. Rehabilitation after lower limb amputation: a comparative study of above-knee, through-knee and Gritti-Stokes amputations. British Journal of Surgery198976622\u2013624. (https:\/\/doi.org\/10.1002\/bjs.1800760633)"},{"key":"bib3","series-title":"Annals of the Royal College of Surgeons of England","first-page":"90","article-title":"A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease","volume":"65","author":"Beacock","year":"1983","unstructured":"Beacock CJDoran JHopkinson BR & Makin GS. A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease. Annals of the Royal College of Surgeons of England19836590\u201392."},{"key":"bib4","series-title":"Operative Orthop\u00e4die und Traumatologie","first-page":"280","article-title":"Transtibial amputation","volume":"23","author":"Baumgartner","year":"2011","unstructured":"Baumgartner R. Transtibial amputation. Operative Orthop\u00e4die und Traumatologie201123280\u2013288. (https:\/\/doi.org\/10.1007\/s00064-011-0040-z)"},{"key":"bib5","series-title":"Foot and Ankle","first-page":"254","article-title":"Transcutaneous oxygen tension in the dysvascular foot with infection","volume":"14","author":"Pinzur","year":"1993","unstructured":"Pinzur MSStuck RSage R & Osterman H. Transcutaneous oxygen tension in the dysvascular foot with infection. Foot and Ankle199314254\u2013256. (https:\/\/doi.org\/10.1177\/107110079301400503)"},{"key":"bib6","series-title":"British Medical Journal","first-page":"837","article-title":"Gritti-Stokes amputation in atherosclerosis: a review of 237 cases","volume":"3","author":"Martin","year":"1967","unstructured":"Martin PRenwick S & Thomas EM. Gritti-Stokes amputation in atherosclerosis: a review of 237 cases. British Medical Journal19673837\u2013838. (https:\/\/doi.org\/10.1136\/bmj.3.5569.837)"},{"key":"bib7","series-title":"Journal of Bone and Joint Surgery","first-page":"602","article-title":"Gritti-Stokes amputations in the trauma patient: clinical comparisons and subjective outcomes","volume":"94","author":"Taylor","year":"2012","unstructured":"Taylor BCPoka AFrench BGFowler TT & Mehta S. Gritti-Stokes amputations in the trauma patient: clinical comparisons and subjective outcomes. Journal of Bone and Joint Surgery201294602\u2013608. (https:\/\/doi.org\/10.2106\/JBJS.K.00557)"},{"key":"bib8","series-title":"Journal of Vascular Surgery","first-page":"107S","article-title":"IP197. Reintroduction of the Gritti-Stokes (above-knee) amputation","volume":"65","author":"Joseph","year":"2017","unstructured":"Joseph TKarmaker ANoel JWiser WWallack M & Finlay D. IP197. Reintroduction of the Gritti-Stokes (above-knee) amputation [Internet]. Journal of Vascular Surgery201765107S\u2013108S. (https:\/\/doi.org\/10.1016\/j.jvs.2017.03.202)"},{"key":"bib9","series-title":"JBJS Essential Surgical Techniques","first-page":"e7","article-title":"Gritti-Stokes amputation in the trauma patient: tips and techniques","volume":"2","author":"Taylor","year":"2012","unstructured":"Taylor BCPoka AMehta S & French BG. Gritti-Stokes amputation in the trauma patient: tips and techniques. JBJS Essential Surgical Techniques20122e7. (https:\/\/doi.org\/10.2106\/JBJS.ST.K.00048)"},{"key":"bib10","series-title":"Annals of Physical and Rehabilitation Medicine","first-page":"101727","article-title":"Prosthetic fitting associated with better survival at 5 years after above- knee amputation due to vascular insufficiency","volume":"66","author":"Bruegger","year":"2023","unstructured":"Bruegger ABorens O & Steinmetz S. Prosthetic fitting associated with better survival at 5 years after above- knee amputation due to vascular insufficiency. Annals of Physical and Rehabilitation Medicine202366101727. (https:\/\/doi.org\/10.1016\/j.rehab.2022.101727)"},{"key":"bib11","series-title":"European Journal of Vascular and Endovascular Surgery","first-page":"248","article-title":"Early post-operative mortality after major lower limb amputation: a systemic review of population and regional based studies","volume":"51","author":"Van Netten","year":"2016","unstructured":"Van Netten JJ & Fortington LV. Early post-operative mortality after major lower limb amputation: a systemic review of population and regional based studies. European Journal of Vascular and Endovascular Surgery201651248\u2013257. (https:\/\/doi.org\/10.1016\/j.ejvs.2015.10.001)"},{"key":"bib12","series-title":"Annals of Vascular Surgery","first-page":"322","article-title":"A Meta-analysis of Long-term Mortality and Associated Risk Factors following lower extremity amputation","volume":"42","author":"Stern","year":"2017","unstructured":"Stern JRWong CKYerovinkina MSpindler SJSee ASPanjaki SLoven SLD\u2019Andrea RF & Nowygrod R. A Meta-analysis of Long-term Mortality and Associated Risk Factors following lower extremity amputation. Annals of Vascular Surgery201742322\u2013327. (https:\/\/doi.org\/10.1016\/j.avsg.2016.12.015)"},{"key":"bib13","series-title":"Vascular","first-page":"1149","article-title":"A review of through-knee amputation","volume":"30","author":"Panhelleux","year":"2022","unstructured":"Panhelleux BShalhoub JSilverman AK & McGregor AH. A review of through-knee amputation. Vascular2022301149\u20131159. (https:\/\/doi.org\/10.1177\/17085381211045183)"},{"key":"bib14","series-title":"Revue Medicale Suisse","first-page":"2409","article-title":"Lower limb amputation: indication, preoperative workup and complications","volume":"10","author":"Zingg","year":"2014","unstructured":"Zingg MNicod\u00e8me JDU\u00e7kay IRay A & Suva D. Lower limb amputation: indication, preoperative workup and complications. Revue Medicale Suisse2014102409\u20132413."},{"key":"bib15","series-title":"Journal of Orthopaedic Science","first-page":"588","article-title":"Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use","volume":"17","author":"Dunkel","year":"2012","unstructured":"Dunkel NBelaieff WAssal MCorni VKaraca \u015eLacraz A & U\u00e7kay I. Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use. Journal of Orthopaedic Science201217588\u2013594. (https:\/\/doi.org\/10.1007\/s00776-012-0245-5)"},{"key":"bib16","series-title":"European Journal of Vascular and Endovascular Surgery","first-page":"75","article-title":"Five day antibiotic prophylaxis for major lower limb amputation reduces wound infection rates and the length of in-hospital stay","volume":"35","author":"Sadat","year":"2008","unstructured":"Sadat UChaudhuri AHayes PDGaunt MEBoyle JR & Varty K. Five day antibiotic prophylaxis for major lower limb amputation reduces wound infection rates and the length of in-hospital stay. European Journal of Vascular and Endovascular Surgery20083575\u201378. (https:\/\/doi.org\/10.1016\/j.ejvs.2007.07.016)"},{"key":"bib17","series-title":"Annals of Vascular Surgery","first-page":"468","article-title":"A reevaluation of the Gritti-Stokes (above-knee) amputation for the nonambulatory patient","volume":"60","author":"Theriot","year":"2019","unstructured":"Theriot JBhattarai P & Finlay DJ. A reevaluation of the Gritti-Stokes (above-knee) amputation for the nonambulatory patient. Annals of Vascular Surgery201960468\u2013473. (https:\/\/doi.org\/10.1016\/j.avsg.2019.03.006)"},{"key":"bib18","series-title":"Revue Medicale Suisse","first-page":"2899","article-title":"Amputations of the lower extremity","volume":"3","author":"Borens","year":"2007","unstructured":"Borens OSaucy FMouhsine EWettstein M & Blanc CH. Amputations of the lower extremity. Revue Medicale Suisse200732899\u20132905."},{"key":"bib19","series-title":"Journal des Maladies Vasculaires","first-page":"261","article-title":"A modified Gritti-Stokes amputation for vascular indications in the elderly: futility or utility?","volume":"36","author":"Lim","year":"2011","unstructured":"Lim CTartaglia ETremblay BAngha S & Gigou F. A modified Gritti-Stokes amputation for vascular indications in the elderly: futility or utility?. Journal des Maladies Vasculaires201136261\u2013269. (https:\/\/doi.org\/10.1016\/j.jmv.2011.06.004)"},{"key":"bib20","series-title":"British Medical Journal","first-page":"574","article-title":"Clinical review of the Gritti-Stokes amputation","volume":"2","author":"Middleton","year":"1962","unstructured":"Middleton MD & Webster CU. Clinical review of the Gritti-Stokes amputation. British Medical Journal19622574\u2013576. (https:\/\/doi.org\/10.1136\/bmj.2.5304.574)"},{"key":"bib21","series-title":"Journal of Vascular Surgery","first-page":"7","article-title":"Functional outcome in a contemporary series of major lower extremity amputations","volume":"38","author":"Nehler","year":"2003","unstructured":"Nehler MRColl JRHiatt WRRegensteiner JGSchnickel GTKlenke WAStrecker PKAnderson MWJones DNWhitehill TA, et al.Functional outcome in a contemporary series of major lower extremity amputations. Journal of Vascular Surgery2003387\u201314. (https:\/\/doi.org\/10.1016\/s0741-5214(0300092-2)"},{"key":"bib22","series-title":"Annals of the Royal College of Surgeons of England","first-page":"102","article-title":"Role of Gritti-Stokes amputation in peripheral vascular disease","volume":"79","author":"Yusuf","year":"1997","unstructured":"Yusuf SWBaker DMWenham PWMakin GS & Hopkinson BR. Role of Gritti-Stokes amputation in peripheral vascular disease. Annals of the Royal College of Surgeons of England199779102\u2013104."}],"container-title":["EFORT Open Reviews"],"original-title":[],"link":[{"URL":"https:\/\/eor.bioscientifica.com\/view\/journals\/eor\/9\/4\/EOR-23-0118.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eor.bioscientifica.com\/downloadpdf\/journals\/eor\/9\/4\/EOR-23-0118.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/eor.bioscientifica.com\/downloadpdf\/journals\/eor\/9\/4\/EOR-23-0118.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:51:10Z","timestamp":1784555470000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/eor\/article\/9\/4\/276-284\/2632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":22,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.1530\/eor-23-0118","relation":{},"ISSN":["2058-5241"],"issn-type":[{"value":"2058-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,1]]}}}