Free Chain-Linked Fillet Flaps From a Contralateral Chopart Amputation for Reconstruction of an Extensive Lower...

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Free fillet flaps are a reconstructive technique using composite tissue from an unsalvageable limb to repair defects.
• This case explores the use of free fillet flaps based on the posterior tibial artery (PTA) and anterior tibial artery (ATA).

Observation:

• A 41-year-old male patient sustained severe open tibia and fibula fractures (Gustilo IIIB) with extensive soft tissue loss.
• The patient underwent a below-knee amputation of the contralateral limb.
• Two free fillet flaps were harvested from the amputated limb: one PTA-based (15x13cm) and one ATA-based (20x8cm).

Findings:

• Chain-linked free fillet flaps were employed via flow-through anastomosis to cover the exposed right tibia.
• Postoperative partial necrosis of the ATA-based flap was successfully managed with reoperation.
• The patient achieved mobility with a prosthesis.

Implications:

• Free chain-linked fillet flaps from amputation segments are a feasible reconstructive option.
• This method addresses complex soft tissue defects effectively.
• It avoids additional donor site morbidity, enhancing patient outcomes.