jbjsest
Surgical Technique for Osteocutaneous Pedicle Flap Transfer for Salvage of Transtibial Amputation After Severe Lower-Extremity Injury
Heather A. Vallier, MD; Brendan M. Patterson, MD; John K. Sontich, MD

Overview

Introduction 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 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.

Results 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 Indications

Contraindications

Pitfalls & Challenges

Introduction

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.

Some injuries generate massive bone loss from the tibia and/or soft-tissue destruction around the proximal part …


Enter your JBJS login information below.

Log in through your institution