IntroductionOsteocutaneous 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 AssessmentIf 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 ImplantsRemove provisional stabilization implants and minimize surgery about the knee.
Step 3: Develop the FlapThe dissection about the tarsal tunnel is the critical portion of the operative technique.
Step 4: Contour the CalcaneusAny deviation from perpendicular will translate to an axial deformity in the reconstructed limb.
Step 5: Prepare the Proximal Part of the Tibia and Surrounding TissuesRetain viable soft tissues and bone, but resect the fibula obliquely.
Step 6: Secure the Calcaneus to the TibiaAvoid varus and recurvatum malalignment.
Step 7: Repair and Reconstruct the Soft TissuesThe injured limb is routinely very swollen, and in some cases complete coverage requires split-thickness skin-grafting.
Step 8: Postoperative Care and RehabilitationAs the initial reconstruction is sometimes extremely bulbous, continually advise the patient that the shape will improve dramatically over time with shrinkage of the limb.
ResultsIn 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 ForIndicationsContraindicationsPitfalls & Challenges