The principles of amputation in children are different from those in adults, although the operational techniques are not very different from those in adults, but the anatomical structure of the limb and the growth and development of the child must be taken into account. The ideal level of amputation in children is not used as a limited routine, however, a more conservative approach is taken in children than in adults, preserving the length of the residual limb as much as possible. In particular, preservation of the articular disarticulation and adjacent epiphyses is preferable to amputation at levels above these. And amputation with preservation of the joint and the distal epiphysis of the joint is preferable to joint disarticulation. A mid-thigh amputation in a five-year-old child becomes a short thigh stump by age fourteen because the distal femoral epiphysis has been removed. A five-year-old child with a short calf amputation, however, because of growth of the proximal calf epiphysis, may form a calf stump of a more satisfactory length by the age of fourteen years, and a suitable calf prosthesis may be worn. Overgrowth of the amputated end of the long diaphysis is due to homotopic growth of new bone and is not related to proximal epiphyseal growth. The length of bone overgrowth varies greatly from amputated child to amputated child, and approximately 8-12% of the patients will require one or more stump revision surgeries. Attempts to prevent overgrowth of the end of the bone by epiphyseal blocking methods are never successful and should be strictly prohibited. This complication occurs most frequently in the humerus and fibula, and less frequently in the tibia, femur, radius, and ulna, in that order. The most effective treatment for this is the removal of the excess bone. In order to minimize the time to reamputation, children and their parents should be taught how to push the skin of the residual limb towards the stump by hand on a regular basis. Because of children’s growth and metabolism, the residual limb after amputation is much more resistant to compression and friction than in adults, and what is intolerable in adults can often be tolerated in children. Children’s skin and subcutaneous tissues are more resistant to suture closure of wounds under tension, and free skin grafts of the middle-thickness skin are more likely than those in adults to provide permanent skin coverage. Even implanted skin is more resistant to compression of the prosthesis. Postoperative complications are also generally not as severe as in adults, and even extensive scarring can be tolerated; children rarely have psychological problems after amputation. Management of the muscle at the amputated end should be by performing a myoplasty, which is used to cover the end of the bone, rather than muscle fixation, which is damaging to the distal end of the bone and may result in overgrowth of the end of the bone; it results in a nail-tip-like end of the bone, which may penetrate the skin and cause infection. Covering the end of the bone with a periosteal osteocortical flap can limit the undesirable overgrowth of the end of the bone. Neuromas generally cause little discomfort and rarely require surgical treatment for neuromas. Phantom limb sensations rarely bother children after amputation. At younger ages of amputation, phantom limb sensations are vague and phantom limb pain rarely occurs. Do not perform osteoplasty (i.e., fusion of the tibiofibular ends) on the tibiofibular stump of a child’s lower leg amputation. Because the proximal epiphyseal growth length of the fibula accounts for a larger proportion than the proximal epiphyseal growth length of the tibia, if the tibiofibular end of the fusion, due to the fibula grows longer than the tibia, the late tibial inversion deformity or the head of the fibula to the proximal end of the subluxation can be caused. Children also have better application of prostheses than adults, and their proficiency in prosthetic application increases with age. Because of children’s mobility, coupled with growth factors, prostheses may require frequent repairs and adjustments, and receptive cavities may have to be replaced or fitted with new prostheses.