Covering the below‐knee amputation stump with the pedicled dorsalis pedis flap from the ipsilateral foot: A case report

Abstract

It is important to preserve the length, appropriate durable skin, and sensation of the stump when performing below-knee amputation to achieve functional ambulation with a prosthesis. There are many reports of reconstruction procedures using microvascular surgery to preserve the optimum length of the amputation stump for prosthesis; however, free tissue reconstruction is necessary to accompany with the donor site morbidity. In this report, we describe our experience with a below-knee amputation and stump covering using the pedicled dorsalis pedis flap from the no longer usable foot in the case of a severe osteomyelitis of a lower extremity after highly contaminated Gustilo type IIIB fracture. We achieved a well-healed amputated stump with enough length for a prosthesis and for protective sensation. The pedicled dorsalis pedis flap is easily elevated without microvascular anastomosis and is one useful option for the reconstruction of the below-knee amputated stump in the specific case.

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presumed inferiority in providing a durable end-bearing stump, a notion that was mainly based on anecdotal reports and outdated studies from the 1970s and 1980s.…”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.…”