Osteocutaneous pedicle flap transfer from the foot can be used to “salvage” a transtibial amputation level when the severity of an injury precludes a transtibial amputation.
Step 1: Preoperative Assessment
If the posterior tibial artery is not palpable, obtain an angiogram to determine the vascular supply distal to the traumatic zone and to prepare for conversion to a composite free microvascular transfer.
Step 2: Remove Provisional Implants
Remove provisional stabilization implants and minimize surgery about the knee.
Step 3: Develop the Flap
The dissection about the tarsal tunnel is the critical portion of the operative technique.
Step 4: Contour the Calcaneus
Any deviation from perpendicular will translate to an axial deformity in the reconstructed limb.
Step 5: Prepare the Proximal Part of the Tibia and Surrounding Tissues
Retain viable soft tissues and bone, but resect the fibula obliquely.
Step 6: Secure the Calcaneus to the Tibia
Avoid varus and recurvatum malalignment.
Step 7: Repair and Reconstruct the Soft Tissues
The injured limb is routinely very swollen, and in some cases complete coverage requires split-thickness skin-grafting.
Step 8: Postoperative Care and Rehabilitation
As the initial reconstruction is sometimes extremely bulbous, continually advise the patient that the shape will improve dramatically over time with shrinkage of the limb.
In our original study, ten men and four women with a mean age of 43.2 years (range, twenty-four to sixty-four years) underwent an osteocutaneous pedicle flap transfer with use of the ipsilateral foot for salvage to achieve a transtibial amputation level.
What to Watch For
Pitfalls & Challenges