Orthopaedic Department of HC-UNICAMP, Campinas, Sao Paulo, Brazil.
J Reconstr Microsurg. 2011 Jan;27(1):63-6. doi: 10.1055/s-0030-1267831. Epub 2010 Oct 13.
Of the possible levels of amputation, transtibial amputations result in functionally excellent outcomes. However, in contrast to hind foot amputations, such as Syme and especially Boyd amputation, acute or late complications related to the amputated stump are frequent with the various described techniques. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) pedicled sensate flap with a surface that allowed full terminal weight-bearing in transtibial amputations in adults. One male patient, 66 years old with schizophrenia and chronic distal tibial osteomyelitis, underwent a leg amputation with sensate composite calcaneal flap construction. The stump was painless and able to bear total terminal weight at 12 weeks. Calcaneum tibial fusion was observed at 12-week postoperative follow-up. A below-knee prosthesis was adapted in 12 weeks, and at the 1-year follow-up, the patient was completely satisfied with the functional performance of his stump. The flap described provides proprioceptive feedback with the best bone and skin to support weight bearing. Another advantage is the possibility to use the same prosthesis commonly used in Boyd or Syme amputation due a longer arm leverage, which also allows full terminal weight-bearing. In the current study, a transtibial amputation covered with a pedicled sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong full weight-bearing terminal surface of the stump that will last a lifetime.
在可能的截肢水平中，胫骨截肢术的功能效果非常出色。然而，与后足截肢术（如 Syme 截肢术和特别的 Boyd 截肢术）不同，各种描述的技术都经常会导致与截肢残端相关的急性或迟发性并发症。本研究的目的是描述一种后足（包括跟骨和脂肪垫）带感觉的皮瓣，其表面允许成人胫骨截肢术后完全负重。一名 66 岁的男性患者，患有精神分裂症和慢性胫骨远端骨髓炎，接受了带有感觉复合跟骨皮瓣的腿部截肢术。在 12 周时，残端无痛且能够承受全部末端负重。术后 12 周随访时观察到跟骨胫骨融合。12 周后适应了小腿假肢，在 1 年随访时，患者对残端的功能表现完全满意。所描述的皮瓣提供了最佳的骨骼和皮肤感觉反馈，以支持负重。另一个优点是由于更长的臂杠杆作用，有可能使用与 Boyd 或 Syme 截肢术相同的假肢，这也允许完全末端负重。在当前的研究中，提出了一种使用保留跟骨的带感觉的足底皮瓣覆盖胫骨的胫骨截肢术。从理论上讲，这种技术中保留的解剖结构提供了一个终生耐用的、强大的、完全负重的残端末端表面。
