Conventional vs Ertl … from a patient’s perspective

The conventional amputation procedure, sometimes referred to as the ‘long-posterior flap’ method, is currently completed using the same methods as amputations were done in the days of the early part of the century (and before), only with better instruments and medications:

  • bone being cut to length, without being closed which allows for it to ‘bleed out’
  • muscle cut to length and allowed to retract (and atrophy over time)
  • arteries and veins sutured together to complete the ‘circulation loop’ (which reportedly causes stress to the heart)
  • nerves severed at location of cut, normally causing neuromas (painful nerve endings) since the cut end isn’t properly dealt with during the procedure.

In a below knee amputation procedure, the tibia and fibula (two bones in the lower leg) aren’t secured to each other, which allows them to ‘chop stick’ (move about) within the residual limb (‘stump’), which can cause varying levels of pain on different days.

Within the Osteomyoplasty Amputation (Etrl) procedure, much more time is taken by the surgeon to ensure the residual limb is prepared for a future prosthetic device. During the procedure:

  • end of the bone(s) is re-established so it is closed and regains it’s normal pressurization (improved bone health and strength)
    —in a below knee amputation, a ‘bridge’ between the tibia and fibula is created for bone stabilization (much like the stabilization created by the ankle)
  • nerves are retracted into the soft tissue area above the amputation site so they can heal in a scar-free, quiet environment
    (sensation of feeling is still available at the end of the residual limb)
  • myoplasty/suturing of opposing muscle groups (side-to-side & front-to-back) underneath the end of the residual limb is completed to re-establish the normal pumping action of the muscles (reduces the likelihood of atrophy)
  • since the myoplasty produces a smooth contour of the limb, and padding at the bottom of residual limb, it is well prepared for the prosthetic device.

There is also a considerable time difference between the two procedures … a conventional takes approximately 60-90 minutes while the Ertl needs approximately 2.5-4 hours (depending if it is a primary or revision surgery and the physical state of the limb). But considering the end results, that short amount of time (in the long run) is well worth the increased potential for returning to a high level of activity.

During all of my research, I have found numerous amputees that have had to undergo revisions (additional surgeries) and used the Ertl procedure to fix/improve the conventional procedure they originally received. I have never found an Ertl amputee that had to use a conventional procedure for revision.