Free flaps to preserve below-knee amputation stumps: long-term evaluation

Area of Science:

• Reconstructive surgery
• Orthopedic surgery
• Tissue engineering

Background:

• Insufficient soft-tissue coverage on below-knee amputation stumps poses challenges for prosthetic fitting.
• Preserving a functional below-knee amputation level is crucial for prosthetic ambulation.

Observation:

• Five patients with below-knee amputation stumps underwent free-tissue transfer surgery.
• Various flaps were used, including latissimus dorsi, groin, and foot-fillet flaps.
• Patients were followed for a mean of 5.5 years, with early outcomes and long-term function assessed.

Findings:

• All free flaps survived, with one requiring revision for venous anastomosis.
• Mean time to prosthetic ambulation was 3.6 months.
• Four patients developed flap-related ulcerations requiring revision; mean prosthesis changes were 1.28 annually.
• Knee joint function and stability were well preserved; all patients achieved full ambulation on their reconstructed stumps.

Implications:

• Free-tissue transfer is a viable option for reconstructing below-knee amputation stumps.
• This technique can enable patients to utilize below-knee prosthetics, improving functional outcomes.
• Further research may focus on minimizing flap ulcerations and optimizing long-term prosthetic integration.