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Published on: August 30, 2020
Lower limb salvage to allow planned trans-tibial amputation
D A L Watt1, M R W Grotz, P V Giannoudis
1Department of Plastic, Reconstructive and Hand Surgery, St James's University Hospital, Leeds, UK. david.watt@bradfordhospitals.nhs.uk
Summary
Early amputation is sometimes needed for severe lower limb trauma. This report shows a successful below-knee amputation achieved through acute limb shortening and flap cover, even when standard reconstruction isn't possible.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Limb Reconstruction
Background:
- High-impact lower limb trauma often necessitates early, primary amputations.
- The turn-up bone flap technique is a reconstructive option for proximal tibial bone loss to create a prosthesis-suitable below-knee stump.
- This technique is not feasible when posterior soft tissues are compromised.
Observation:
- A case report details the management of a severe open proximal tibial fracture.
- Standard reconstructive methods were not suitable due to the nature of the injury.
- The patient required an alternative surgical approach for limb salvage or amputation.
Findings:
- A successful below-knee amputation was achieved using acute limb shortening.
- Flap cover was utilized to manage the soft tissue defect.
- A planned, subsequent trans-tibial amputation was performed.
Implications:
- This approach offers a viable alternative for limb salvage in complex proximal tibial fractures.
- It demonstrates the adaptability of surgical techniques when standard methods fail.
- Successful below-knee amputation can be achieved even with extensive injury, enabling prosthesis use.
