The level of amputation is determined by measurements taken from preoperative imaging studies. Measurements are made from the top of the greater trochanter and from the knee joint line. If the level of amputation permits, a pneumatic tourniquet is used for hemostasis. A sandbag is placed under the ipsilateral buttock.

The following areas are marked: 1. Intended bone level of amputation. 2. Midpoints of the medial and lateral aspects of the thigh 1 cm above the bony level. 3. Distal border of the anterior and posterior incisions

The last is determined by a rule of thumb; the combined length of the anterior and posterior flaps is slightly longer than the diameter of the thigh at the intended bone level, and the length of the anterior flap is twice the diameter of the posterior flap.

A to C, The skin incision begins at the midpoint of the medial aspect of the thigh, gently curves anteriorly and inferiorly to the distal border of the anterior incision, and passes convexly to the midpoint on the lateral aspect of the thigh. The posterior incision starts at the same medial point, extends to the distal margin of the posterior flap, and swings proximally to end at the midpoint on the lateral thigh.

D,

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