Authors: Anton Johannesson, PhD, CPO Gert-Uno Larsson, MD Nerrolyn Ramstrand, PhD, CPO Henrik Lauge-Pedersen, PhD, MD Philippe Wagner, MS Isam Atroshi, PhD, MD Affiliations: From the Department of Clinical Sciences (AJ, HL-P, IA), Lund University, Lund, Sweden; Department of Orthopedics (G-UL, IA), Ha ¨ssleholm-Kristianstad, Ha ¨ssleholm Hospital, Ha ¨ssleholm, Sweden; Department of Rehabilitation (NR), Jo ¨ nko ¨ ping University, Jo ¨ nko ¨ ping, Sweden; and Swedish National Competence Center for Musculoskeletal Disorders, Department of Orthopedics (PW), Lund University Hospital, Lund, Sweden. Correspondence: All correspondence and requests for reprints should be addressed to Anton Johannesson, PhD, CPO, Centralsjukhuset, SE-291 85 Kristianstad, Sweden. 0894-9115/10/8904-0293/0 American Journal of Physical Medicine & Rehabilitation Copyright © 2010 by Lippincott Williams & Wilkins DOI: 10.1097/PHM.0b013e3181cf1bee Outcomes of a Standardized Surgical and Rehabilitation Program in Transtibial Amputation for Peripheral Vascular Disease A Prospective Cohort Study ABSTRACT Johannesson A, Larsson G-U, Ramstrand N, Lauge-Pedersen H, Wagner P, Atroshi I: Outcomes of a standardized surgical and rehabilitation program in transtibial amputation for peripheral vascular disease: A prospective cohort study. Am J Phys Med Rehabil 2010;89:293–303. Objective: To study the outcomes of a new surgical and rehabilitation program for initial unilateral transtibial amputation in patients with periph- eral vascular disease. The program consists of sagittal incision, rigid dressing, compression therapy using silicone liner, and direct manufac- turing prosthetic technique. Design: A prospective cohort study with 1-yr follow-up. Results: Of the 217 consecutive patients with peripheral vascular disease who underwent transtibial amputation (mean age, 77 yrs; 51% diabetic; 116 could walk before amputation), 119 (55%) were fitted with a prosthesis at a median time of 41 (range, 12–147) days after ampu- tation. Of the prosthetic recipients, 76 (64%) obtained good function with the prosthesis within 6 mos. Within 1 yr, reamputation was performed on 8.2%, and contralateral amputation was performed on 5.5%. The 90-day mortality was 24% (53 patients). The total 1-yr mortality was 40% (86 patients): 17% among patients who received a prosthesis and 67% among those who did not receive a prosthesis or had undergone ream- putation. Conclusions: Following this standardized surgical and rehabilitation program, prosthetic fitting was achieved in more than half of transtibial amputees, almost two-thirds of prosthetic recipients obtained good func- tion, and the reamputation rate was low. Comparison with outcomes of alternative strategies is needed. Key Words: Lower Limb, Amputation, Prosthetic, Mortality www.ajpmr.com Rehabilitation in Transtibial Amputation 293 ORIGINAL RESEARCH ARTICLE Amputee