Reconstruction of Below Knee Stump with Free Plantar Fillet Flap: A Case Report

Abstract

Here, we present a 45-year-old male patient who had right leg fracture in several pieces, arterial ischemia, multiple muscle, tendon losses and degloving injury on the distal thigh and knee undergoing emergency surgery due to a high-energy traffic accident and explain our experience with reconstruction of below knee stump using free plantar fillet flap in order to prevent above knee amputation in a patient with vascular injuries, multi-part fractures and soft tissue losses in the lower extremity.

Exploring the Role of Free Tissue Transfers in the Preservation of Bone Length and Knee Joint Function after Lower Limb Trauma: A Retrospective Analysis

“…Primary coverage of amputated stumps with "spare parts" surgery, which avoids additional donor site morbidity, is rare in clinical practice due to concerns about wound contamination, infection risk, and questionable tissue perfusion, especially in patients with severe trauma [3,10,[20][21][22][23][24]. In our study, only one flap was used immediately for stump reconstruction, and the majority of reconstructions were performed later after proper debridement and wound preparation.…”

“…While the common practice involves straightforward limb shortening by reducing bone length and using healthy soft tissues from the proximal area, this approach may result in significant bone shortening and the removal of a healthy, functional knee joint, causing irreversible harm to the patient's future ambulation. However, the use of complex tissue transfers can be potentially beneficial in cases where there is soft tissue deficiency without the need for bone shortening, allowing for the preservation of the knee joint (Figure 1) [1][2][3][10][11][12][13][14][15][16][17][20][21][22][23][24][25]. The decisionmaking process for patients after traumatic amputation, based on soft tissue sufficiency, is illustrated in Figure 2.…”

“…However, the use of complex tissue transfers can be potentially beneficial in cases where the is soft tissue deficiency without the need for bone shortening, allowing for the preservation the knee joint (Figure 1) [1][2][3][10][11][12][13][14][15][16][17][20][21][22][23][24][25]. The decision-making process for patients after trau matic amputation, based on soft tissue sufficiency, is illustrated in Figure 2.…”