Extremity Reconstruction Using the “Fillet of Sole” Flap

Russell, Robert C.; Vitale, Victoria; Zook, Elvin C.

doi:10.1097/00000637-198607000-00012

Cited by 45 publications

(18 citation statements)

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“…13,19,20 In both of our cases, above-knee amputation was performed because of the extensive soft-tissue and bony injuries at the knee joint. During the initial period, the stump was left open and was closed at a later stage.…”

Section: Discussionmentioning

confidence: 96%

Ipsilateral Replantation of Foot with Crossover Segmental Transfer in Bilateral Leg Amputation

Srivastava

2005

Plastic and Reconstructive Surgery

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Traumatic amputation of the lower extremity is not uncommon. The indication for lower extremity replantation may be controversial. 1,2 Replantation is considered if a sensate weightbearing extremity could be reconstructed 3-7 and in cases of bilateral amputation. [1][2][3]5,[7][8][9][10][11] Use of parts of nonreplantable tissue as "spare parts" surgery has also been described for both upper and lower extremity amputations. [12][13][14][15][16][17] Bilateral amputation of the lower extremities is challenging. Anatomic replantation is advocated, and successful replantation of both lower extremities has been reported. 1,3,9 -11 When anatomic replantation of both extremities is not possible, crossover replantation has been reported to salvage at least one extremity, because the mobilization achieved by a crossover replanted foot in combination with prosthesis is better than that with two artificial limbs, as reported by Chen and Zeng. 4 Instead of performing crossover replantation, we modified the technique by using segmental transfer of leg tissue from the contralateral amputated limb to salvage one extremity. This modification in technique, which we used in the two cases reported in this article, allowed for "ipsilateral orthotopic replantation" of the foot using vessels in the transferred segment as flow-through vessels to reconstruct the vascular architecture of the salvaged extremity with revascularization of the foot. It also restored nearly normal anatomy of the salvaged extremity. CASE REPORTS Case 1In April of 2001, a 32-year-old man presented with massive injuries to both lower extremities after being run over by a train. His left lower extremity was totally amputated and his right foot was subtotally amputated (Fig. 1). No additional injury was noted, and the patient was in hypovolemic shock. Intensive therapy to compensate for blood and fluid loss was started immediately. After 2½ hours of ischemia time, the patient was taken for operation. After the right lower extremity wound was débrided and cleaned, the tibia and fibula were shortened by 10 cm, with loss of ankle mortise. The continuity of the Achilles tendon, the tibialis anterior, tibialis posterior, and flexor hallucis longus muscles, and the posttibial nerve were intact (Fig. 2). Débridement of the right foot resulted in exposure of the ankle joint; the articular surface of the talus was intact (Fig. 2). Orthotopic replantation of the right foot was planned with cross-over segmental transfer of the lower third of the leg with ankle mortise from the amputated left lower extremity. Anatomic replantation of the left lower extremity was not possible because of extensive softtissue and bony damage; amputation was completed above the knee joint. The lower third of the leg and the foot were preserved (Fig. 1).In the right lower extremity, the posterior tibial artery and venae comitantes were anastomosed temporarily to the anterior tibial artery and venae comitantes (Fig. 2) to reduce the total ischemia time of the right foot. The lower third of the ...

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Section: Discussionmentioning

confidence: 96%

Ipsilateral Replantation of Foot with Crossover Segmental Transfer in Bilateral Leg Amputation

Srivastava

2005

Plastic and Reconstructive Surgery

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“…The heel pad was then secured over the anterior aspect of the tibia and any remaining areas of soft tissue deficit were covered with a split skin graft. Russel et al 1 accurately review the anatomy and precise technique of flap elevation.…”

Section: Methodsmentioning

confidence: 99%

The Role of the Very Long Posterior Tibial Artery Flap following Severe Lower Limb Trauma

Sayed

Kelemen

Williams

et al. 2013

Plastic and Reconstructive Surgery Global Open

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Summary:With advancing techniques, knowledge, and training, the decision to salvage a lower limb following severe trauma is becoming ever more popular and successful. However, in cases where amputation is inevitable due to extensive injury or infection, we encourage the use of the very long posterior tibial artery (VLPTA) flap when the sole of the foot and posterior tibial neurovasculature are intact. We report 3 patients who underwent below-knee amputation and reconstruction using the VLPTA flap. A literature review was also performed to identify the outcomes and any complications associated with VLPTA flap.

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“…freie Lappenplastik in der plastisch-rekonstruktiven Chirurgie verwendet wird. Russell et al führten den Begriff des Filetlappens 1986 als Teil des "Ersatzteil"-Konzepts in die Extremitätenrekonstruktion ein [21]. Der klassische Filetlappen ist ein axialer Lappen, der aus traumatisch amputierten und nicht zu replantierenden bzw.…”

Section: Filetlappenunclassified

Plantare neurovaskuläre Filetlappenplastik

Küntscher

Erdmann

Levin

et al. 2003

Chirurg

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Sensory denervation is the key factor for the high rate of recurrent sacral pressure sores in paraplegic patients. This paper summarizes the results after reconstruction of recurrent sacral pressure sores using a sensory innervated plantar fillet free flap. Five plantar fillet free flaps were utilized for defect reconstruction of sacral pressure sores in five male patients during a 9-year period (1989-1998). Data were analyzed retrospectively. Patients'age ranged between 32 and 51 years. The level of spinal cord injury was between T10 and L1. The average defect size was 20 x 16 cm. All flaps were microsurgical free tissue transfers. The posterior tibial nerve was coapted to two intercostal nerves from above the spinal cord injury level. All patients developed sensation within 3-6 months. A stable sensate coverage was achieved in each case. The data show that the concept of a sensory innervated plantar fillet free flap may facilitate defect reconstruction in most complex or even seemingly hopeless cases.

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Extremity Reconstruction Using the “Fillet of Sole” Flap

Cited by 45 publications

References 0 publications

Ipsilateral Replantation of Foot with Crossover Segmental Transfer in Bilateral Leg Amputation

Ipsilateral Replantation of Foot with Crossover Segmental Transfer in Bilateral Leg Amputation

The Role of the Very Long Posterior Tibial Artery Flap following Severe Lower Limb Trauma

Plantare neurovaskuläre Filetlappenplastik

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