Salvage of foot amputation stumps of Chopart level by free medial plantar flap.

Abstract

Blast energy-induced traumas usually result in some type of amputations of lower extremities. It is very hard to determine the amputation level of the feet of these cases at first, and secondary amputation stump revisions by bone shortening are often necessary. Among partial foot amputation levels, Chopart level is the most critical. Four male patients (20 to 24 years old) with modified Chopart amputation due to mine explosion injury have had skin-grafted amputation stumps where troublesome, recurrent unstable wounds had developed. These amputation stumps were electively reconstructed with neurosensorial free medial plantar flaps from unaffected feet without any bone shortening. All the transferred flaps survived and adapted to stumps well, and patients were ambulated at the second month by wearing on the original prosthesis after minimal adjustments. At the follow-up period (6 months to 2 years), no skin breakdown of the stumps was evident. Monofilament (Semmes-Weinstein) tests revealed diminished light touch in two patients and diminished protective sensation in another two patients at the sixth month. Temporary donor foot pain, which existed by walking for 3 months, may be due partly to absence of plantar fascia supporting the plantar arc. We suggest that amputation level of Chopart is the most critical of partial foot amputations in young patients and should be reconstructed with flaps if there is not sufficient soft-tissue coverage of amputation stump; free neurosensorial medial plantar flap would be the primary choice with its advantages.