Of the possible levels of amputation, transtibial amputations result in functionally excellent outcomes. However, in contrast to hind foot amputations, such as Syme and especially Boyd amputation, acute or late complications related to the amputated stump are frequent with the various described techniques. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) pedicled sensate flap with a surface that allowed full terminal weight-bearing in transtibial amputations in adults. One male patient, 66 years old with schizophrenia and chronic distal tibial osteomyelitis, underwent a leg amputation with sensate composite calcaneal flap construction. The stump was painless and able to bear total terminal weight at 12 weeks. Calcaneum tibial fusion was observed at 12-week postoperative follow-up. A below-knee prosthesis was adapted in 12 weeks, and at the 1-year follow-up, the patient was completely satisfied with the functional performance of his stump. The flap described provides proprioceptive feedback with the best bone and skin to support weight bearing. Another advantage is the possibility to use the same prosthesis commonly used in Boyd or Syme amputation due a longer arm leverage, which also allows full terminal weight-bearing. In the current study, a transtibial amputation covered with a pedicled sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong full weight-bearing terminal surface of the stump that will last a lifetime.

Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised limb, or even a limb affected by a congenital malformation, usually gives poorer functional results compared with amputation and prosthetisation. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) sensate flap with a surface that allows full terminal weight bearing in transtibial amputations in adults. Between June 2007 and September 2008, eight patients underwent leg amputations with a sensate composite calcaneal flap reconstruction of the stump. Patients consisted of four men and four women with a mean age of 46.5 (26–66) years. All amputations were unilateral. The mean follow-up was 28.3 (25–42) months. There were no complications. Calcaneum tibial fusion was observed in all patients in a mean time of 3.5 (3–4) months. A below-knee prosthesis was adapted at 16 weeks postoperatively in all cases, and no need for stump revision occurred in this series during the entire follow-up period. A transtibial amputation covered with a sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong, full, weight-bearing terminal surface of the stump that will last a lifetime.