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Updated: Jul 27, 2025

Modified Heterotopic Hindlimb Osteomyocutaneous Flap Model in the Rat for Translational Vascularized Composite Allotransplantation Research

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Secondary amputation after lower extremity free-flap reconstruction.

F K Wong¹, S Fruge¹, M Z Meulendijks²

¹Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS

|June 8, 2023

Summary

Infection is the primary reason for secondary lower extremity amputation after free-flap reconstruction. While many patients achieve prosthetic ambulation, chronic pain remains a significant concern post-amputation.

Keywords:

Amputation Free flap Lower extremity reconstruction Rehabilitation

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Inhibition of Wound Epidermis Formation via Full Skin Flap Surgery During Axolotl Limb Regeneration

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Published on: June 24, 2020

Area of Science:

Orthopedic Surgery
Reconstructive Surgery
Microsurgery

Background:

Microsurgical free-tissue transfer is a key reconstructive method for lower extremity limb salvage.
Secondary amputation may be necessary despite successful initial free-flap reconstruction due to complications.
Indications for secondary amputation include non-union, malunion, infection, hardware failure, or chronic pain.

Purpose of the Study:

To determine the causes and outcomes of secondary amputation following lower extremity free-flap reconstruction.
To analyze the etiology and patient-reported outcomes after secondary amputation in this patient cohort.

Main Methods:

Retrospective cohort study of patients undergoing lower extremity free-flap reconstruction (2002-2020).
Identification of patients who subsequently underwent amputation.
Patient-reported outcomes assessed using the PROMIS® Pain Interference Scale and activities of daily living (ADLs) survey.

Main Results:

9.8% (40/410) of patients underwent secondary amputation.
Infection was the most common cause (68%, 27/40) of secondary amputation.
Of survey respondents, 80% (12/15) could ambulate with a prosthetic limb.

Conclusions:

Infection is the leading etiology for secondary amputation after lower extremity free-flap reconstruction.
While prosthetic ambulation is achievable for most, chronic pain is prevalent.
Findings can inform patients about the risks and outcomes associated with lower extremity free-flap reconstruction.