Modified dorsalis pedis flap for coverage of a pretibial pressure sore after hip rotationplasty

Rotationplasty is a well-established procedure after total femur resection, especially in children. Rehabilitation is superior to disarticulation of the hip or hemipelvectomy because patients regain hip and knee function.(1) A tight fit of the prosthetic shaft is essential. The pretibial area has a low physiological resistance to pressure and shear forces, and is thus at increased risk of developing pressure-related complications. Skin defects with exposure of skeletal elements require flap coverage. The dorsalis pedis flap is one of the surgical options available for skin coverage of the proximal anterior leg. It can be rotated to cover almost any site on the anterior aspect of the leg if the pedicle is mobilised up to the anterior tibial artery.(2)Since donor site complications are common, this flap has few indications.(3)