I decided to blog about my Ertl revision because there really is not that much information for prospective patients. The only other bona fide blog I came across is over at codeverity.com
Basically, what distinguishes the Ertl procedure from traditional below-knee amputations is the "bone bridge" that secures the tibia and fibula (i.e., the leg bones below the knee) together.
I guess the one thing I should settle right away is that I'm aware that the "true" Ertl procedure does not involve a fibular strut (i.e., a piece of the fibula that is sutured or screwed in place to form the bone bridge.) Instead, a periosteal sachet filled with a slurry of bone chips is fashioned between the tibia and fibula. This eventually forms solid bone. The fibular strut method certainly heals faster, but whether one approach is "better" than another is purely anecdotal, in my opinion. The studies I've read cannot state the clinical superiority of either method.
I decided to have my surgery at the Cleveland Clinic, under the care of Dr Dan Clair. I have family in Cleveland, and it's a great hospital, so it seems like the best option.
Lastly, why the revision? I'm currently what I would describe as a "very long below-knee amputee." I basically have the length of a Syme amputee, but I do not have a heel pad. In fact, a skin graft was required to achieve closure, so weight bearing was never really a possibilty. Thus, I have none of the benefits of a Syme (mainly the ability to ambulate without a prosthesis) and all of the difficulties of an extremely long limb. Actually, BK amputations in the distal third of the tibia are contraindicated because of a lack of soft tissue to cushion the bone. Also, because of my length, my prosthetic options are extremely limited. Shock absorption (which would help me considerably) is not an option, so I'm limited to zero-impact activities. Having a BK of "standard" length opens up a whole new world of prosthetic options. And having an Ertl revision opens up the possibility of a weight-bearing limb.
