J Korean Med Sci.  2014 Feb;29(2):305-308. 10.3346/jkms.2014.29.2.305.

A Case of Nonisland Pedicled Foot Fillet Flap for Below-Knee Amputation Stump Wound: Treatment Option for Compartment Syndrome after Fibular Free Flap Surgery

• Hwang JH
• Kim KS
• Lee SY

• KMID: 1789994
• DOI: http://doi.org/10.3346/jkms.2014.29.2.305

Abstract

Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation.

Keyword

Compartment Syndromes; Fibula; Knee; Amputation; Foot; Surgical Flaps

MeSH Terms

Aged
Amputation
Compartment Syndromes/*diagnosis/etiology
Drainage
Free Tissue Flaps/*adverse effects
Humans
Knee Joint/physiology
Leg/*surgery
Male
Postoperative Complications

Figure

• 

  Fig. 1 A 66-year-old man who had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome and an extensive soft tissue defect of the left leg. (A) Lateral view of the left leg at 47 days after the initial fibular free flap transfer. The skin incisions were performed along the dashed lines. (B) Intraoperative view after tibial osteotomy and flap elevation. (C) Immediate postoperative appearance after below-knee amputation and wound coverage with a nonisland pedicled foot fillet flap. (D) Follow-up view at 7 months after below-knee amputation and flap coverage. The flap was well healed with improving sensation to the skin flap and the patient was satisfied with the result.

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