Surgical Technique for Osteocutaneous Pedicle Flap Transfer for Salvage of Transtibial Amputation After Severe Lower-Extremity Injury.

Abstract

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. 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. Remove provisional stabilization implants and minimize surgery about the knee. The dissection about the tarsal tunnel is the critical portion of the operative technique. Any deviation from perpendicular will translate to an axial deformity in the reconstructed limb. Retain viable soft tissues and bone, but resect the fibula obliquely. Avoid varus and recurvatum malalignment. The injured limb is routinely very swollen, and in some cases complete coverage requires split-thickness skin-grafting. 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. IndicationsContraindicationsPitfalls & Challenges.