Below Knee Stump Reconstruction with a Foot Fillet Flap
20. Juni 2017
31. Juli 2017
06. Oktober 2017 (online)
Background The “spare parts” approach to the reconstruction of below knee amputation, applied in acute trauma patients, can also be employed in elective surgery, ensuring knee salvage and a sensitive stump and enabling tissue harvesting without further donor-site morbidity.
Methods We present a series of eight cases, where leg amputation due to trauma or its sequelae was followed by reconstruction with skin or a composite flap from the foot. An osteocutaneous flap was used in two emergency patients with below knee amputation, where it allowed stump elongation and knee coverage, and in five secondary procedures, where it provided both stump length and sensitive skin coverage. The skin of the foot was used in one case to cover the tibial stump. Fixation was accomplished with 2-mm Kirschner wires in the emergency patients and with an external fixator (n = 5) or by internal fixation (n = 1) in the elective procedures. Any complications were minor. Secondary compression with an external fixator was required in one emergency patient due to delayed bone healing.
Results All knees healed. Sensibility was restored in all patients with a posterior tibial nerve suture (S4) and was well preserved in those without nerve coaptation. No patients reported problems with the prosthesis at a minimum follow-up of 3 years. Knee flexion and extension were comparable to those of the contralateral limb.
Conclusion The “spare parts” concept is a reliable approach to tibial stump reconstruction. External fixation in elective procedures allowed immediate weight bearing and bone healing. In emergency patients, rapid fixation with wires provided satisfactory results.
- 1 Colen SR, Romita MC, Godfrey NV, Shaw WW. Salvage replantation. Clin Plast Surg 1983; 10 (01) 125-131
- 2 Jupiter JB, Tsai TM, Kleinert HE. Salvage replantation of lower limb amputations. Plast Reconstr Surg 1982; 69 (01) 1-8
- 3 Russell RC, Vitale V, Zook EC. Extremity reconstruction using the “fillet of sole” flap. Ann Plast Surg 1986; 17 (01) 65-72
- 4 Frykman GK, Jobe CM. Amputation salvage with microvascular free flap from the amputated extremity. J Trauma 1987; 27 (03) 326-329
- 5 Küntscher MV, Erdmann D, Homann HH, Steinau HU, Levin SL, Germann G. The concept of fillet flaps: classification, indications, and analysis of their clinical value. Plast Reconstr Surg 2001; 108 (04) 885-896
- 6 Ghali S, Harris PA, Khan U, Pearse M, Nanchahal J. Leg length preservation with pedicled fillet of foot flaps after traumatic amputations. Plast Reconstr Surg 2005; 115 (02) 498-505
- 7 Chiang YC, Wei FC, Wang JW, Chen WS. Reconstruction of below-knee stump using the salvaged foot fillet flap. Plast Reconstr Surg 1995; 96 (03) 731-738
- 8 Tran NV, Evans GR, Kroll SS. , et al. Free filet extremity flap: indications and options for reconstruction. Plast Reconstr Surg 2000; 105 (01) 99-104
- 9 Hidalgo DA, Shaw WW. Dorsalis pedis and “foot fillet” free flaps. In: Microsurgery in Trauma. Mount Kisco, NY: Futura Publishing Company; 1987
- 10 Laporta R, Atzeni M, Longo B, Santanelli di Pompeo F. Double free fillet foot flap: sole of foot and dorsalis pedis in severe bilateral lower extremity trauma, a 10-year follow-up case report. Case Reports Plast Surg Hand Surg 2016; 3 (01) 62-65
- 11 Battiston B, Tos P, Pontini I, Ferrero S. Lower limb replantations: indications and a new scoring system. Microsurgery 2002; 22 (05) 187-192
- 12 Chung KC, Saddawi-Konefka D, Haase SC, Kaul G, Kaul G. A cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures. Plast Reconstr Surg 2009; 124 (06) 1965-1973
- 13 Pribaz JJ, Morris DJ, Barrall D, Eriksson E. Double fillet of foot free flaps for emergency leg and hand coverage with ultimate great toe to thumb transfer. Plast Reconstr Surg 1993; 91 (06) 1151-1153
- 14 Waters RL, Perry J, Antonelli D, Hislop H. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am 1976; 58 (01) 42-46
- 15 Kayikçioğlu A, Ağaoğlu G, Nasir S, Keçik A. Crossover replantation and fillet flap coverage of the stump after ectopic implantation: a case of bilateral leg amputation. Plast Reconstr Surg 2000; 106 (04) 868-873