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Skew flap for staged below-knee amputation in sepsis
Christopher O Matthews1, Ian M Williams1, Peter Lewis1
1South East Wales Vascular Network, Royal Gwent Hospital, Newport, Wales, UK.
Vascular
|May 24, 2015
Summary
Skew flap amputation offers a key advantage over traditional methods, particularly in complex cases with sepsis and skin loss. This technique improves stump healing by positioning the suture line away from the tibia, reducing bone exposure risks.
Area of Science:
- Surgical techniques in limb amputation
- Wound healing and tissue coverage
- Management of lower extremity sepsis
Background:
- The long posterior flap amputation is a common surgical technique for below-knee amputations.
- Skew flap amputation, described in the 1980s, has not gained widespread popularity.
- Challenges in stump healing often arise from skin coverage issues and bone exposure.
Observation:
- This case report details a staged below-knee amputation performed in a patient with severe sepsis and extensive leg infection.
- The patient presented with significant pus throughout the leg and compromised skin coverage.
- The skew flap technique was chosen due to the critical wound conditions.
Findings:
- A previously undocumented benefit of skew flaps is that the suture line is not positioned directly over the tibia.
- This anatomical advantage makes the technique more forgiving in cases of incomplete skin coverage or open wounds.
- The suture line's position over the skew flap, rather than the tibia, prevented bone exposure and facilitated stump healing in this complex case.
Implications:
- Skew flap amputation may be a valuable alternative in complex below-knee amputations, especially those involving sepsis and compromised soft tissues.
- The technique's inherent design can reduce the risk of complications like bone exposure and the need for revision surgery.
- Further investigation into the utility of skew flaps in challenging amputation scenarios is warranted to optimize patient outcomes.