Division of Plastic and Reconstructive Surgery, Department of Surgery, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008 S. Spring Ave, Suite 1500., St. Louis, MO, 63110, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Eur J Orthop Surg Traumatol. 2024 Dec;34(8):4083-4091. doi: 10.1007/s00590-024-04111-5. Epub 2024 Oct 1.
Forequarter and hindquarter amputations have traditionally been closed with local tissues, but the technique is plagued by a high rate of complication such as marginal necrosis, seroma, infection, and dehiscence. Filet of limb flaps have been used when local tissues are insufficient for closure, and despite their use in more extensive and complex wounds, outcomes seem to be better in these cases. Recognizing that filet of limb flaps not only serve to cover the wound, but also eliminate dead space, supplement at-risk and/or radiated tissue, pad underlying hard structures, and facilitate neuroma prevention with target muscle reinnervation, we have change our practice to utilize buried filet of limb flaps even when local tissues are technically "sufficient" to close the wound. The purpose of this article to organize and describe the ways in which buried filet-of-limb flaps can be used to achieve important and discrete surgical objectives in forequarter and hindquarter amputation, and to facilitate increased recognition of collaborative interdisciplinary opportunities for spare-part reconstruction.
Retrospective data from the medical records of seven patients, collected between 2010 to 2023 at our single tertiary referral center, were reviewed. This included all patients for whom a buried (or partially buried) filet of limb flap was attempted for forequarter or hindquarter amputation reconstruction.
Five males and two females ranging 55 to 75 years of age, met the inclusion criteria. Three cases of forequarter amputation and four cases of hindquarter amputation were included. Six flaps were successfully transferred without major flap-related complications. The mean follow-up period was eight and a half months.
Even when local tissues are technically "sufficient" to close forequarter and hindquarter amputation wounds, we have found buried filet of limb flaps to be useful in several ways. These include occupying dead space, providing double-layer coverage, padding hard structures, preventing neuromas, and reconstructing sacro- and spino-pelvic continuity. Our approach emphasizes interdisciplinary collaboration and highlights the potential advantages of buried filet of limb flaps in optimizing patient outcomes for complex limb amputations.
传统上，前肩部和后肩部截肢术采用局部组织闭合，但该技术存在较高的并发症发生率，如边缘坏死、血清肿、感染和裂开。当局部组织不足以闭合伤口时，会使用肢体皮瓣，但尽管它们被用于更广泛和复杂的伤口，在这些情况下结果似乎更好。认识到肢体皮瓣不仅用于覆盖伤口，还消除死腔，补充有风险和/或放射治疗的组织，填充下方的硬结构，并通过靶肌肉再神经支配促进神经瘤预防，我们改变了实践，即使在局部组织在技术上“足够”闭合伤口时，也使用埋藏式肢体皮瓣。本文的目的是组织和描述埋藏式肢体皮瓣在肩部和髋部截肢中用于实现重要和离散手术目标的方法，并促进对剩余部分重建的协作跨学科机会的更多认识。
回顾性收集了 2010 年至 2023 年在我们单一的三级转诊中心的七名患者的病历数据。这包括所有尝试用埋藏（或部分埋藏）肢体皮瓣进行肩部或髋部截肢重建的患者。
符合纳入标准的患者为 5 名男性和 2 名女性，年龄在 55 至 75 岁之间。包括 3 例肩部截肢和 4 例髋部截肢。6 个皮瓣成功转移，没有与皮瓣相关的主要并发症。平均随访时间为 8 个半月。
即使局部组织在技术上“足够”闭合肩部和髋部截肢伤口，我们也发现埋藏式肢体皮瓣在以下几个方面很有用。这些包括占据死腔、提供双层覆盖、填充硬结构、预防神经瘤和重建骶骨和脊柱骨盆连续性。我们的方法强调了跨学科合作，并强调了埋藏式肢体皮瓣在优化复杂肢体截肢患者结局方面的潜在优势。
