Preservation of lower extremity spare parts using the University of Wisconsin solution

Abstract

The management of a mangled limb is a challenging endeavor. With the advancement in microsurgery, spare parts surgery (fillet flaps) has gained recent interest. In the context of lower extremity amputation secondary to trauma, viable spare parts can provide stump soft tissue coverage, potentially preserving critical length and obviating above-knee amputations. Commonly, spare parts surgery is performed in the acute setting but tissue preservation is sometimes necessary. The authors report their experience preserving a fillet flap of a mangled lower extremity for 48 h using the University of Wisconsin solution. A sole fillet flap and a split-thickness skin graft were harvested and preserved from the amputated lower extremity (based on the posterior tibial artery and vein). Stump coverage was achieved by anastomosing the fillet flap to the proximal posterior tibial artery and vein. This solution has not been previously described for preservation of fillet flaps.

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.…”

Pedicled hand fillet flap to preserve stump length in below-elbow amputation

“…Skin grafting was not considered for stump coverage, as split-thickness skin grafts can develop ulceration or overt wound failure in the context of direct pressure and shear forces from regular prosthesis wear [ 7 ]. Coverage with vascularized tissue is preferred [ 11 ]. Lastly, while above-elbow amputation, in theory, may have been an acceptable approach given the associated brachial plexopathy and lack of elbow flexion and extension, the patient’s preference was to proceed with below-elbow amputation in hopes of maintaining the potential for a below-elbow prosthesis where he ever to regain motor function at the elbow.…”