Thigh Fillet Flap for Pelvic Reconstruction in a Traumatic Hind-Quarter Amputation

Traumatic hind-quarter amputation is an uncommon injury, usually associated with significant mortality due to intraabdominal associated trauma.

A case of a 16-year-old male with a traumatic right hemipelvectomy was reported. The peritoneum and intraperitoneal organs were not injured. The right testis was lost and the rectum had a penetrating wound. There was also an associated open tibial fracture. Primary replantation was not considered. Although direct skin closure was possible, reconstruction of the pelvic wall was considered important to prevent postoperative pelvic hernia. A fillet flap was harvested from the amputated limb, including the rectus femoris, vastus lateralis and ALT flap, based on the lateral circumflex and common femoral vessels. The fillet flap was used to reconstruct the pelvic floor, suturing the muscular part to the abdominal muscles, the sacrum, levator ani muscle, and pubic synphysis. The free flap was revascularized end-to-end to the stump of the external iliac vessels. A temporary transverse colostomy was performed. The postoperative course was uneventful, with colostomy reversal on postoperative day 15. The patient is fully continent and is able to walk single-legged.