Reconstruction of a Massive Traumatic Necrotizing Wound With Contiguous Anterior Thigh and Lower Leg Fillet Flap With Leg and Hemipelvic Amputation

Frank, Tym; Hill, Mark K.; Clarkson, Paul W.

doi:10.1177/2513826x17728259

Cited by 1 publication

(5 citation statements)

References 13 publications

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“…30 This flap type may be the final treatment option and lifesaving procedure for such patients. 3,10,18 However, the lower-extremity fillet flap is a complicated surgical procedure that can cause complications such as infection, hematoma, and wound dehiscence. 24 Therefore, the patient and surgeon should decide on the nature of the operation and complications.…”

Section: Discussionmentioning

confidence: 99%

“…The lower-extremity fillet flap is generally prepared from nonfunctional lower extremities and is used as a pedicled or free flap in the repair of large tissue defects in the pelvis and sacral regions resulting from tumor excision and crush injury. 6,[9][10][11][13][14][15][16][17][31][32][33][34] This flap has rarely been used for extensive stage IV pressure sore repairs. 1,2,3 The entire lower-extremity fillet flap (with the foot) has rarely been used to repair defects resulting from crush injury, tumor excision, and wide stage IV pressure sores.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the patient and surgeon should decide on the nature of the operation and complications. The lower-extremity fillet flap is generally prepared from nonfunctional lower extremities and is used as a pedicled or free flap in the repair of large tissue defects in the pelvis and sacral regions resulting from tumor excision and crush injury 6,9–11,13–17,31–34 . This flap has rarely been used for extensive stage IV pressure sore repairs 1,2,3 .…”

Section: Discussionmentioning

confidence: 99%

“…A lower-extremity fillet flap may be a good and rational option for the repair of complex stage IV pressure sores, particularly when the flap is removed from a nonfunctional leg, which limits the mobility of patients with paraplegia. The lower-extremity fillet flap has been used for the repair of hemipelvectomy and complex stage IV pressure sores 2,6,9–17 . A foot fillet flap can be used alone or as part of the total lower-extremity fillet flap in pressure sore repair 15,18–20 .…”

mentioning

confidence: 99%

“…The lower-extremity fillet flap has been used for the repair of hemipelvectomy and complex stage IV pressure sores. 2,6,[9][10][11][12][13][14][15][16][17] A foot fillet flap can be used alone or as part of the total lower-extremity fillet flap in pressure sore repair. 15,[18][19][20] Considering the unique pressure absorption and redistribution properties of the plantar part, the foot is used as a pedicled or free foot fillet flap in the repair of amputation stumps.…”

mentioning

confidence: 99%

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Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding

Turan

2023

Ann Plast Surg

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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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