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Related Experiment Video

Updated: Dec 22, 2025

Engineered Vascularized Muscle Flap
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[Local flaps as a last attempt to avoid lower extremity amputation: an overview].

Rafael G Jakubietz1, Rainer H Meffert2, Michael G Jakubietz2

  • 1Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland. Jakubietz_R@ukw.de.

Der Unfallchirurg
|May 10, 2020
PubMed
Summary

For aged patients needing soft tissue reconstruction, local flaps are a salvage option when free tissue transfer is not possible. Careful donor site selection is crucial to avoid compromising future below-knee amputation stump coverage.

Keywords:
Multimorbid patientsPedicled flap reconstructionPerforator flapPeroneus brevis muscle flapSural artery flap

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Area of Science:

  • Reconstructive surgery
  • Orthopedic surgery
  • Plastic surgery

Background:

  • Soft tissue reconstruction in elderly patients presents unique challenges.
  • Free tissue transfer is successful in healthy older adults but contraindicated in multimorbid patients.
  • Local flaps are often used as a salvage procedure in high-risk patients but have high complication rates.

Purpose of the Study:

  • To evaluate distally based local flaps for soft tissue reconstruction in aged, multimorbid patients.
  • To analyze donor site selection for local flaps, considering potential future amputations.
  • To identify optimal flap choices to prevent negative impacts on below-knee amputation stump coverage.

Main Methods:

  • Review of three distally based local flaps: sural artery flap, peroneus brevis muscle flap, and perforator-based propeller flaps.
  • Assessment of donor site placement and associated wound healing complications.
  • Evaluation of flap utility in the context of potential below-knee amputation.

Main Results:

  • The sural artery flap's donor site in the proximal dorsal calf is disadvantageous.
  • Harvesting from this area can compromise soft tissue coverage for a below-knee amputation stump.
  • Other local flaps may offer better donor site options without impacting future amputation management.

Conclusions:

  • When selecting local flaps for salvage surgery to avoid amputation in patients unsuitable for free tissue transfer, donor site considerations are paramount.
  • The proximal dorsal distal calf region is essential for potential below-knee amputation stump coverage and should be preserved.
  • Choosing alternative local flap donor sites is recommended to ensure adequate coverage for future reconstructive needs.