Transtibial amputation in ischemic limbs. A, Fashioning of short anterior and long posterior skin flaps. B, Separation and removal of distal leg. Muscle mass is tailored to form flaps. C, Suture of flap to deep fascia and periosteum anteriorly. (Redrawn from Burgess EM, Zettl JH: Amputations below the knee, Artif Limbs 13:1, 1969.) SEE TECHNIQUE 16.3.