Immediate amputation stump coverage with forearm free flaps from the same limb

Rees, M. J.; Geus, J. J. De

doi:10.1016/s0363-5023(88)80066-2

Cited by 28 publications

(10 citation statements)

References 7 publications

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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: 94%

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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: 94%

“…[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.…”

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confidence: 99%

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

Srivastava

2005

Plastic and Reconstructive Surgery

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“…In these cases, tissue from the amputated extremity may be used to achieve immediate and reliable soft tissue coverage of large defects. [5][6][7][8][9][10][11] A partial preservation of the shoulder girdle has significant advantages in addition to minimizing the disfigurement. 3 The bony prominence improves fitting and use of a functional myoelectric prosthesis.…”

Section: Discussion and Summarymentioning

confidence: 99%

Combination of a Total Free Forearm Flap and a Sensate Local Flap for Preservation of the Shoulder Girdle in Massive, Nonreplantable Upper Extremity Injuries

Jakubietz

Kloss

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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This challenging procedure helps to achieve durable and sensate coverage of bony prominences. The use of local sensate tissue to cover bony prominences reduces the risk for pressure ulceration when wearing a prosthesis. Areas where prosthetic use causes only low pressure and shearing forces are adequately covered with free flaps. Immediate sensibility of local flaps allows prosthetic fitting and use as soon as wound healing has occurred. Return to work is thus expedited.

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“…These have been described in both the upper limb [4,9,14] and the lower limb [2,7,10,15]. Waterhouse et al [16] in 1984 reported the use of an extended free radial forearm flap to cover a denuded segment of tibia after traumatic amputation of an upper and lower limb.…”

Section: Discussionmentioning

confidence: 99%

A salvage composite free flap for improved prosthetics

et al. 2003

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A post-traumatic composite skin, muscle and bone defect in the left thigh with a 14-cm bone gap in the femur was secondarily reconstructed with a salvage osseomyocutaneous microvascular free tissue transfer of the tibia (18 cm), calf muscles and overlying skin (26×13 cm) harvested from the lower leg. The latter was amputated for chronic trophic ulceration of the foot and causalgia resulting from damage to the femoral and sciatic nerve in the primary injury. This situation resulted in an above-the-knee amputation stump with a better fitting and a more convenient prosthesis, rather than amputation at the hip joint.

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Immediate amputation stump coverage with forearm free flaps from the same limb

Cited by 28 publications

References 7 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

Combination of a Total Free Forearm Flap and a Sensate Local Flap for Preservation of the Shoulder Girdle in Massive, Nonreplantable Upper Extremity Injuries

A salvage composite free flap for improved prosthetics

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