I had a below the knee amputation. i have a blister like spot that oozes a little blood & won't heal. my vascular surgeon is talking above the knee revision. is this necessary for a smal blister that just seems like it needs more skin over it. i have good

This : This is a tough question to answer without more information. How small is "small"? Where is the blister located? Are you wearing a prosthesis? How long has it been since you first saw the blister? How were you able to determine that you have good circulation? Without this information, i would suggest that if the blister is not infected and is not causing pain and doesn't limit your ability to wear a prosthesis, local wound care would be reasonable with the expectation that it may never heal, or heal very slowly. If you are able to provide more information, myself and other physicians may be able to advise you more appropriately.

I : I would agree with the comments made above that it is difficult to give an exact answer without more information. Couple of things i would mention you should know when you discuss this with the surgeon. When a below knee amputation doesn't heal properly there are generally only several causes, the first is poor circulation (you mention you have "good circulation" but has was that determined?). It is very difficult for the leg to heal without adequate circulation. The second would be too much pressure on part of the leg. There are many causes of this but typically it would be from a prosthesis that is poorly fitted or a splint or cast that is too tight, also if you are developing a contracture (your knee is bent) then the end of your leg is constantly rubbing on the bed or other surface while you sleep this can also cause an ulcer. Last would be an infection in the leg, you mention a "small blister" but sometimes a small blister can have a deep and serious infection under it (do you have fever or other signs of infection)? I don't know your age or if the plan was for you to walk with a prosthesis or not but i can tell you that walking with an above knee prosthesis is much, much more difficult than walking with a below knee prosthesis. If it is at all possible to preserve the knee it is something you will want to do if you are planning on being able to walk.

Comments : Comments by drs. Hernandez and bilof are good. A discussion with your surgeon on why he wants to revise the amputation is mandatory. Should you have edema of the stump, with a spot that doesn't heal, then consider venous incompetence, which is not commonly recognized as contributing to poor healing. Performing a venous study of the amputated leg would help in identifying this problem. A recent obese, diabetic lady on Insulin had bka, and the lateral incision stayed open for 6 months (quarter size). She had stump edema, and the great saphenous vein was dilated and incompetent, and after ablation of the gsv, the lateral ulcer healed in two weeks.