<< Back to the abstract archive
Preserving the Knee with High Segmental Tibial Bone and Massive Soft Tissue Loss with Vascularized Distal Tibial Bone Docking and a Foot Fillet Flap
Garyn T. Metoyer BS, Spencer R. Anderson MD, Brandon R. Horne MD, Salim N. Mancho DO, Sunishka M. Wimalawansa MD MBA
Wright State University School of Medicine
2019-02-15
Presenter: Garyn T. Metoyer BS
Affidavit:
I certify that the material of this abstract has not been presented nor published elsewhere, and both the named resident and medical student have contributed to the production of this paper
Director Name: R. Michael Johnson, MD MPH
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Traumatic crush injuries of the extremities often present with substantial operative challenges, including complex segmental bone and tissue loss and risk of osteomyelitis. When lower leg amputation is considered, preservation of the knee will preserve a significant functional advantage. Very high segmental lower leg injuries pose a unique challenge regarding both soft tissue management and the potential for a stump that is too short for prosthetic docking. We discuss our reconstructive approach to preserving the knee and restoring functional length to a below-knee stump.
Methods: Retrospective chart review was performed, with detailed description of operative management and post operative outcome assessment.
Case: A 32-year-old male presented following left lower extremity crush injury. Proximal tibial osteomyelitis, and massive anterior lower leg soft tissue loss would warrant above-knee amputation per conventional management. Knee-sparing reconstruction was performed using a pedicled vascularized distal tibial bone flap docked into the proximal tibia via modified hindfoot fusion intramedullary nail and soft tissue resurfacing with a sensate ipsilateral foot fillet flap.
Results: Patient ambulates with good prosthetic fit, 90 degrees of active knee motion, excellent stump sensation and weight-bears on durable heel pad skin.
Conclusion: Knee preservation adds significant functional benefits in the setting of lower extremity amputation. Soft tissue reconstruction with a foot fillet flap provides sufficient robust, glaborous tissue coverage and excellent sensation to a trans-tibial residual limb. Additional benefits include potential to decrease pressure ulcer development and improve prosthetic wear tolerance.
