DATE AND TIME: [Date and time]
URGENCY: Elective / Non-elective
SURGEON: [Name]
ASSISTANT: [Name / None]
ANAESTHETIST: [Name]
OPERATION: Below Knee Amputation (Burgess Long Posterior Flap)
ANAESTHETIC: General / spinal anaesthesia
ANTIBIOTICS: IV antibiotics at induction
DVT PROPHYLAXIS: [Agent / mechanical / Not indicated]
POSITION: Supine. Urinary catheter.
INDICATION:
Unsalvageable lower limb — [chronic critical ischaemia / acute ischaemia failing revascularisation / extensive diabetic foot sepsis / gangrene]. Level of amputation chosen at most distal site where reliable healing predicted. Vascular / surgical MDT agreement.