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Harnoncourt L, Gstoettner C, Pflaum L, Laengle G, Aszmann OC. [Fillet flap transfer as alternative to conventional lower limb amputation]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:651-659. [PMID: 38985169 PMCID: PMC11341707 DOI: 10.1007/s00113-024-01460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect. OBJECTIVE An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts. MATERIAL AND METHODS A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, a clinical case is presented. RESULTS AND CONCLUSION The transfer of the sole of the foot as a fillet flap to the weight-bearing region of the amputation stump offers a number of benefits, such as creating a fully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.
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Affiliation(s)
- L Harnoncourt
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - C Gstoettner
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - L Pflaum
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
| | - G Laengle
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - O C Aszmann
- Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich.
- Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Xiao C, Gebremariam NE, Nthumba P. The Use of the Pedicled Nonislanded Foot Fillet Flap to Avoid an Above-the-Knee Amputation after Trauma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6070. [PMID: 39206211 PMCID: PMC11350333 DOI: 10.1097/gox.0000000000006070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/26/2024] [Indexed: 09/04/2024]
Abstract
Background Lower extremity trauma can have a devastating effect on the quality of the life of patients. To avoid limb amputation and its associated social stigma, many patients spend years undergoing multiple costly procedures, with prolonged hospital stays, all the while hoping for an elusive limb salvage. People with lower limb amputation experience higher energy requirements for walking, reduced aerobic capacity, and slower walking speeds, when compared with people with normal limbs. A below-knee amputation (BKA) is functionally superior to an above-knee amputation. Methods Between 2012 and 2023, five patients underwent BKAs with a nonislanded foot fillet flap reconstruction of the BKA stump. Four of these patients had undergone previous multiple procedures in attempts at limb salvage. While two patients had sustained recent trauma, three were operated on electively. Results All the BKA stumps healed without any complications. Only one patient complained of phantom limb pain. One patient will require the reconstruction of a lateral knee collateral ligament. Conclusions This case series demonstrates the versatility of the pedicled foot fillet flap in addressing the different complications of lower extremity injury that may result in an unusable limb. The utility of this technique is especially valuable in low-resource settings where the built environment may be unfriendly to nonbipedal ambulation, and an urgent need for a return to economic productivity. Because prostheses are fairly accessible in Kenya, return to ambulation and economic productivity are anticipated following a BKA.
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Affiliation(s)
- Connie Xiao
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Peter Nthumba
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
- Department of Plastic Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Baylor College of Medicine, Temple, Tex
- EACH Research, Kijabe, Kenya
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Turan A. Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding. Ann Plast Surg 2024; 92:230-239. [PMID: 37962214 DOI: 10.1097/sap.0000000000003733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life. METHODS We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap. RESULTS No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month. CONCLUSIONS These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.
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Affiliation(s)
- Aydın Turan
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Gaziosmanpaşa University Medical School, Tokat, Turkey
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Yeap I, Soliman B, Symes M, Wang T. The pedicled fillet-of-sole flap as a reconstructive option for stump reconstruction in chronic osteomyelitis. ANZ J Surg 2024; 94:267-269. [PMID: 37905721 DOI: 10.1111/ans.18755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/08/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Isobel Yeap
- Department of Plastic and Reconstructive Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bishoy Soliman
- Department of Plastic and Reconstructive Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Symes
- Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Tim Wang
- Department of Plastic and Reconstructive Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Krześniak NE, Hsu CC, Chen SH, Lin YT, Lin CH, Lo YH, Anggelia MR, Lin CH. Exploring the Role of Free Tissue Transfers in the Preservation of Bone Length and Knee Joint Function after Lower Limb Trauma: A Retrospective Analysis. J Pers Med 2024; 14:160. [PMID: 38392593 PMCID: PMC10890581 DOI: 10.3390/jpm14020160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality. A retrospective study conducted at Chang Gung Memorial Hospital (2009-2016) focused on lower limb amputation patients who underwent soft tissue transfers at different time periods compared to those without stump reconstruction. Out of the 2391 cases of lower limb injuries treated operatively, 117 amputations were performed in 110 patients (44 above the knee and 73 below the knee). Among them, 12 patients received soft tissue transfers for limb salvage and soft tissue deficiency after amputations. It was observed that patients in this group were typically younger, predominantly female, had longer hospital stays, and underwent a greater number of surgical procedures (p < 0.05). Through the use of soft tissue transfers, successfully preserved tibial bone length and functional knee joint in selected patients was achieved. This approach effectively resolved soft tissue deficiencies following lower limb amputations, optimizing physiotherapy and facilitating functional rehabilitation.
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Affiliation(s)
- Natalia Ewa Krześniak
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, 01-813 Warsaw, Poland
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
| | - Youh-Hua Lo
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
| | - Madonna Rica Anggelia
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan 333, Taiwan
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Toro G, Cecere AB, Braile A, Cicco AD, Liguori S, Tarantino U, Iolascon G. New insights in lower limb reconstruction strategies. Ther Adv Musculoskelet Dis 2023; 15:1759720X231189008. [PMID: 37529331 PMCID: PMC10387789 DOI: 10.1177/1759720x231189008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/04/2023] [Indexed: 08/03/2023] Open
Abstract
High Energy Musculoskeletal Traumas (HEMTs) represent a relevant problem for healthcare systems, considering the high social costs, and both the high morbidity and mortality. The poor outcomes associated with HEMT are related to the high incidence of complications, including bone infection, fracture malunion and non-union. The treatment of each of these complications could be extremely difficult. Limb reconstruction often needs multiple procedures, rising some questions on the opportunity in perseverate to try to save the affected limb. In fact, theoretically, amputation may guarantee better function and lower complications. However, amputation is not free of complication, and a high long-term social cost has been reported. A comprehensive literature review was performed to suggest possible ways to optimize the limb preservation surgeries of HEMT's complications in order to ameliorate their management.
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Affiliation(s)
- Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Benedetto Cecere
- Unit of Orthopaedics and Traumatology, San Giuliano Hospital, Giugliano in Campania, Naples, Italy
| | | | - Annalisa De Cicco
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy Unit of Orthopaedics and Traumatology, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Dadaci M, Yildirim MEC, Uyar I, Ince B. Reconstruction of Below Knee Stump with Free Plantar Fillet Flap: A Case Report. World J Plast Surg 2020; 9:339-342. [PMID: 33330013 PMCID: PMC7734941 DOI: 10.29252/wjps.9.3.339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Mehmet Dadaci
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey
| | - Mehmet Emin Cem Yildirim
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey.,Bilecik State Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic, Bilecik, Turkey
| | - Ilker Uyar
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey.,Tokat State Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic, Tokat, Turkey
| | - Bilsev Ince
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Konya, Turkey
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