Harnoncourt L, Gstoettner C, Pflaum L, Laengle G, Aszmann O C
Klinisches Labor für Bionische Extremitätenrekonstruktion, Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Wien, Österreich.
Universitätsklinik für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Unfallchirurgie (Heidelb). 2024 Sep;127(9):651-659. doi: 10.1007/s00113-024-01460-y. Epub 2024 Jul 10.
The fitting of a prosthesis after lower limb amputation is associated with several challenges. Skeletal stump-prosthesis interfaces and selective nerve transfer can partially overcome these but are also associated with new impairments that emphasize the necessity of innovative approaches. The concept of so-called spare part surgery with the use of fillet flaps could play an important role in this respect.
An overview of the classical prosthesis-associated discomforts, advantages and disadvantages of treatment strategies and presentation of alternative surgical concepts.
A selective literature search was carried out considering the experiences of the authors and perspectives with respect to the advantages and disadvantages of the surgical treatment options. Furthermore, a clinical case is presented.
The transfer of the sole of the foot as a fillet flap to the weight-bearing region of the amputation stump offers a number of benefits, such as creating a fully weight-bearing stump, prevention of neuralgia, preserved sensation and conservation of the body image. As long as the calcaneal region is not impaired, this technique can be performed in amputations below as well as above the knee. The question of whether parts of the bone should be included in the transfer must be individually evaluated for each patient. This approach enables optimization of the residual limb stump for the subsequent fitting of a prosthesis for the patient.
下肢截肢后假体的适配存在诸多挑战。骨骼残端 - 假体界面和选择性神经转移可部分克服这些问题，但也会带来新的功能障碍，这凸显了创新方法的必要性。在这方面，所谓利用鱼际皮瓣的“备用零件手术”概念可能发挥重要作用。
概述与假体相关的传统不适、治疗策略的优缺点，并介绍替代手术概念。
结合作者的经验以及手术治疗方案优缺点的观点进行了选择性文献检索。此外，还展示了一个临床病例。
将足底作为鱼际皮瓣转移至截肢残端的负重区域有诸多益处，例如形成完全负重的残端、预防神经痛、保留感觉以及维持身体形象。只要跟骨区域未受损，该技术可用于膝下截肢以及膝上截肢。对于每位患者，是否应在转移中包含部分骨骼的问题必须单独评估。这种方法能够为患者后续适配假体优化残肢残端。
