Orthoplastic Reconstruction after Lower Limb Major Amputation

Introduction: Major amputation cannot always be avoided in severe lower limb traumas. The aim should be optimal length and good function.

Methodology and Material: This paper presents 26 patients with major traumatic amputations with acute of chronic stump problems. The mean age was 29 years, and 21 were males. Five patients presented with bilateral amputations of the lower limbs, 4 bilateral below knees, and one above the knee, all were victims of a railroad accident. In three patients both limbs could be replanted with shortening and with latissimus cover if indicated, and in one case the resulting length discrepancy was later corrected with 8 cm bone lengthening. In one case the other limb could be orthotopically replanted while the other below knee stump was covered with a fillet flap to achieve a functional B-K stump. In one case with bilateral above knee amputation the better lower left was heterotopically replanted with rotationplasty.

In two cases with distal femoral bone necrosis, the tibial tissues were turned over 180 degree to create a long functional stump (resembling knee disarciculation). In two high femoral amputees, the short non-functional stump was cover with musculocutaneous free flap, and the bone was then lengthened 6-8 cm to allow fitting of the prostheses.

Results: 17 patients with tibial amputation stump problems had a free flap reconstruction for the stump. If the amputated part was available, and the patient´s general condition allowed (3 cases) the distal foot area was used as a fillet flap to cover the stump. In other cases (14) the stump was later covered with a free flaps to get better stump allow the use of the prostheses.

Conclusions: Especially in major traumas individually tailored methods should be used. Orthoplastic reconstruction can be applied in severe lower limb amputations to get better stumps, optimal function and quality of life.