The Symes amputation can be one of the best amputation of the lower extremity.  When it is done right, it creates an excellent end-bearing stump and  allows for a functionally most satisfactory prosthesis.  When is is done badly, the procedure is useless and the patient must be amputated at a higher level.  Problems include posterior migration of the heel pad, skin slough, and a distal flair that leads to a bulky and thus non-cosmetically pleasing prosthesis. 

    The level of the amputation in generally at the distal tibia and fibula 0.6cm proximal to the periphery of the ankle joint and passing through the dome of the ankle centrally.  In the past, the Symes amputation was less used for ischemic limbs because of poor wound healing at this level.  However, newer techniques for determination of tissue perfusion such as Doppler ultrasound measurement of segmental blood pressures, radioactive xenon clearance tests, and transcutaneous oxygen measurements have significantly increased the success rate of the Symes amputation in these limbs.  


The MRI images below demonstrate the level of the Symes amputation along with bony and soft tissue changes.  Note the thick heel pad forming the majority of the distal stump: the principle advantage of this procedure due to the more effective weight bearing.

Symes MRISymes MRI


Symes MRISymes MRI


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