Anterolateral musculocutaneous flap for reconstruction of bone expose of lower leg amputation stump which on the verge of reamputation

Abstract

Objective To explore the curative effect of anterolateral musculocutaneous flap to repair the soft defect of the lower leg amputation stump which on the verge of reamputation, and preserved the length of leg or the knee joint to improve prosthetic limb function. Methods Four patients with soft defect and bone expose of proximal leg amputation stump were enrolled in this study from April, 2013 to November, 2016. Each patient underwent stump revision using anterolateral musculocutaneous flap, including 3 free musculocutaneous flaps and 1 pedicle musculocutaneous flap. The patients were all male with the mean age of 20(8-48) years. The wound was treated debridement, and reconstructed on the second stage. Defect area was from 7.0 cm×6.0 cm to 25.0 cm×10.0 cm. Anterolateral musculocutaneous flaps was from 13.0 cm×10.0 cm to 28.0 cm×12.0 cm. The length of preservation tibia stump was from 5.2 cm to 9.4 cm. Results All patients were followed-up from 12 months to 37 months (average, 19 months). All the musculocutaneous flaps survived completely with a soft tissue texture, elastic, and very wear-resisting. The sensory return was determined to be S2 in 2 patients, S3 in 1 patient and S3+ in 1 patient. The 6-Minute Walk Test: grade IV in 2 cases, grade III in 2 cases; Stanmore movement classification: gradeV in 2 cases, grade IV in 2 cases. Conclusion The anterolateral musculocutaneous flap maybe is an ideal flap to provid stable coverage for the stump of leg amputation which on the verge of reamputation. Key words: Anterolateral thigh musculocutaneous flap; Amputation; Reconstruction; Microsurgical technique