Microsurgical Free Flap Transfer to Amputation Sites: Indications and Results

Abstract

A series of microsurgical free flap reconstructions to amputation stumps of the upper as well as the lower extremities was reviewed in 7 male and 2 female patients. Indications included preservation of length after trauma in 6 patients and cure of local infection in 2 patients. In 1 patient an extensive defect after resection of a recurrent shoulder sarcoma required use of a complete arm fillet free flap for tumor reconstruction. Microvascular free flaps used included four scapular flaps, two fillet flaps from the amputated extremity, one anterolateral thigh flap, and one lateral arm flap. Seven of 9 patients were fitted with a prosthesis and underwent occupational therapy resulting in ambulatory and improved functional status. Microvascular reconstruction is indicated in emergency settings as well as for elective reconstruction of amputation sites. Using uninjured "spare parts" of the amputated extremity should be considered. Elective reconstruction is performed preferably with free flaps based on the subscapular vascular system.

Composite Forearm Free Fillet Flaps to Preserve Stump Length Following Traumatic Amputations of the Upper Extremity

“…3 Similar techniques are well documented using free fasciocutaneous flaps for coverage of upper-arm traumatic amputations and following tumor resection of the upper extremity. 1-7 However, composite free fillet flaps utilizing the "spare parts technique" from the amputated segment for reconstruction of upper-extremity defects after trauma are more limited, 2,4 with our experience being the largest in the literature to date.…”

“…3 This "spare parts or free fillet flap" concept is well documented and widely used for lower-extremity stump preservation 2,4 but only recently has been reported for upper-arm traumatic amputations or following radical upperextremity tumor resections. [1][2][3][4][5][6][7] The aforementioned technique uses only fasciocutaneous flaps rather than composite flaps. Composite free fillet flaps from the amputated upper arm utilizing the superficial flexor musculotendon units (flexor carpi radialis and flexor carpi ulnaris) adjacent to the vascular pedicles (radial, ulnar, and brachial arteries) are not well described or documented.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] However, none describe these free fillet flaps as composite tissue free fillet flaps. We present 8 cases of composite forearm free fillet flaps covering humeral and shoulder soft tissue defects following traumatic amputation.…”

Reconstruction of a transmetatarsal amputation stump using a salvaged peroneal artery fasciocutaneous flap from the opposite leg: A case report

“…Every attempt should be made to preserve an adequate stump length, particularly in young patients, to enable the proper fitting of the prosthesis. This may be achieved by free tissue transfers or by using uninjured spare parts from the amputated extremity (9,10).…”

The Fate of Lower Extremities With Failed Free Flaps

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Because of its unique topography, an entire circumferential anatomic unit of the lower extremity is often damaged, as opposed to the trunk or head and neck regions. The frequent large zone of injury presents a unique management challenge and certainly accounts for the higher rate of flap failure in this region compared with other anatomic areas.…”