Free fillet foot flap for salvage of below-knee amputation stump

Skin grafts provide durable end-bearing coverage for lower-extremity amputations with critical soft tissue loss

Lower-extremity amputations in the presence of soft tissue loss represent an unresolved conundrum because surgeons must consider sacrificing bone length to obtain adequate soft tissue coverage. Local flaps and microvascular soft tissue transfers are established strategies for maintaining residual limb length. However, the use of skin grafts remains controversial due to the presumed inferiority compared with flaps with regard to enabling prosthetic fitting and full weight bearing. The current study was designed to test the hypothesis that split-thickness skin grafts represent a safe and feasible option to preserve bone length in lower-extremity amputations with critical soft tissue loss.

Amputations in natural disasters and mass casualties: staged approach

Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.