Cavadore Nicolas, Lancien Ugo, Crenn Vincent, Verdier Julien, Perrot Pierre
Plastic and Reconstructive Surgery, University Hospital of Nantes, Nantes, FRA.
Orthopaedics and Traumatology, University Hospital of Nantes, Nantes, FRA.
Cureus. 2023 Aug 3;15(8):e42917. doi: 10.7759/cureus.42917. eCollection 2023 Aug.
Traumatic amputation is a severe injury that requires urgent surgical care. A fillet-free flap from the amputated limb is the most conservative way to ensure proper coverage of the stump when replantation is not possible. We report the case of a male patient who suffered from a traumatic limb amputation in a motorcycle accident. A free fillet flap from the posterior compartment of the leg carrying the posterior tibial pedicle, the soleus muscle, and skin tissue harvested from the amputated limb was performed to cover the amputation stump and thus allow preservation of the knee joint. In our case report, the patient conserved almost maximal knee joint range of motion (130°). He regained the ability to walk only two months after the initial trauma. Prosthetic fitting occurred quickly and without any particular issues throughout the process. Regarding quality of life, after one year, our patient had a five-level EQ-5D version (EQ-5D-5L) score of 21,221, and his 36-Item Short Form Survey (SF-36) score was divided between the five components in 85 points in physical functioning, 100 points in role limitations due to physical health, 100 points in role limitations due to emotional problems, 50 points in energy/fatigue, 68 points in emotional well-being, 75 points in social functioning, 45 points in pain, and 95 points in general health. This technique helped provide good coverage of the stump while preserving a functional knee joint, allowing for effective prosthetic fitting in the future and therefore optimizing our patient's quality of life.
创伤性截肢是一种严重损伤，需要紧急手术治疗。当无法进行再植时，取自截肢肢体的无肌皮瓣是确保残端得到妥善覆盖的最保守方法。我们报告一例男性患者，其在摩托车事故中遭受肢体创伤性截肢。采用取自截肢肢体的携带胫后蒂、比目鱼肌和皮肤组织的小腿后外侧游离肌皮瓣覆盖截肢残端，从而保留膝关节。在我们的病例报告中，患者保留了几乎最大的膝关节活动范围（130°）。他在初次受伤仅两个月后就恢复了行走能力。整个过程中假肢适配迅速且没有任何特殊问题。关于生活质量，一年后，我们的患者在欧洲五维健康量表（EQ - 5D - 5L）上的得分为21221，其在36项简明健康调查问卷（SF - 36）中的得分在五个维度上分别为：生理功能85分、因身体健康导致的角色受限100分、因情绪问题导致的角色受限100分、精力/疲劳50分、情绪健康68分、社会功能75分、疼痛45分、总体健康95分。该技术有助于在保留功能性膝关节的同时很好地覆盖残端，为未来有效的假肢适配提供可能，从而优化我们患者的生活质量。
