Osteocutaneous Pedicle Flap Transfer for Salvage of Transtibial Amputation After Severe Lower-Extremity Injury

Abstract

A novel technique has been developed to salvage a transtibial amputation level with use of a rotational osteocutaneous flap from the hindfoot. In the absence of adequate tibial length and/or soft-tissue coverage to salvage the entire limb or to perform a conventional-length transtibial amputation, this technique is a highly functional alternative that does not require microvascular free tissue transfer.

Skin Grafts Provide Durable End-bearing Coverage for Lower-extremity Amputations With Critical Soft Tissue Loss

“…6,27,28 Therefore, multiple surgical techniques of soft tissue reconstruction have been described to achieve preservation of adequate residual limb length. [9][10][11][12][13][14][15][16] Despite the undebated notion that local or free microvascular flaps provide highquality end-bearing stumps, multiple limitations exist for these techniques, [9][10][11][12][13][14][15][16] including a high degree of microsurgical skills required for performing such sophisticated procedures, the resulting donor-site morbidity, and the individual risk factors and comorbidities that may render a specific subset of patients poor candidates for microvascular flaps and free tissue transfers. 29,30 Split-thickness skin grafts have had a bad reputation for many decades due to the presumed inferiority in providing a durable end-bearing stump, a notion that was mainly based on anecdotal reports and outdated studies from the 1970s and 1980s.…”

“…8 Multiple surgi-cal procedures for soft tissue reconstruction have been described to allow preservation of residual limb length using local or remote soft tissue flaps and other techniques. [9][10][11][12][13][14][15][16] However, the use of split-thickness skin grafts for the salvage of lower-extremity amputations with skin loss remains controversial, 17,18 and the historic perception that adequate prosthetic fitting may not be successfully accomplished with skin grafts was challenged recently. [19][20][21][22] The current study was designed to test the hypothesis that split-thickness skin grafts represent a safe strategy to provide end-bearing durable skin for soft tissue loss in lowerextremity amputations.…”

Surgical Technique for Osteocutaneous Pedicle Flap Transfer for Salvage of Transtibial Amputation After Severe Lower-Extremity Injury

“…In our original study, ten men and four women with a mean age of 43.2 years (range, twenty-four to sixtyfour years) underwent an osteocutaneous pedicle flap transfer with use of the ipsilateral foot for salvage to achieve a transtibial amputation level 7 . Because of bone and/or soft-tissue injury, none of these patients could have been treated with conventional transtibial amputation providing a functional length and durable stump.…”

Acute femoral shortening for reconstruction of a complex lower extremity crush injury

“…Unlike many pediatric amputations, commonly required for congenital limb or oncologic conditions, the soft tissues of the adult traumatized limb frequently dictate amputation level. In addition, only in unique circumstances are more distal aspects of an injured limb in the adult able to be moved proximally to achieve length [ 14 ].…”