Staged calcaneus osteocutaneous filet flap for salvage of transtibial amputation

Preserving the Knee in the Setting of High Segmental Tibial Bone and Massive Soft-Tissue Loss Using Vascularized Distal Tibial Bone Docking and a Foot Fillet Flap: A Case Report

CASE

We discuss our reconstructive approach to avoid an above-knee amputation in a 33-year-old man presenting after lower extremity crush injury. We used a vascularized tibial bone flap and a foot fillet flap to restore length and joint functionality to the residual limb. The patient ambulates with good prosthetic fit on durable heel pad skin and 100° active knee motion.

CONCLUSION

This pairing of intramedullary nail with vascularized bone flap and fillet flap to address soft-tissue coverage and retain limb length is a useful tool in traumatic lower extremity injury management, providing an alternative technique for tibial bone graft stabilization with robust, sensate tissue coverage.

A Combined Distal Tibial Turn-up Plasty and Intercalary Calcaneal Osteocutaneous Fillet Flap for Salvage of a Transtibial Amputation: A Case Report

CASE

This case demonstrates the successful attempt at a combined distal tibial turn-up plasty and intercalary calcaneal osteocutaneous fillet flap to increase functional limb length in order to salvage a transtibial amputation following a high-energy blast injury.

CONCLUSION

A transtibial amputation is preferred over more proximal levels of amputation because of the decreased energy expenditure that is required for ambulation. In cases where there is not enough viable tibia to allow for a transtibial level of amputation, combining a calcaneal osteocutaneous fillet flap with a distal tibial turn-up plasty can be utilized to optimize residual limb length for a transtibial amputation.