[Use of tissue expansion on defective amputation stumps of the lower limbs. Apropos of 5 cases].

Skin flaps are usually required to cover amputation stumps, especially below the knee. Cross-leg flaps or free flaps can be used when local tissue is insufficient, but as emphasized by Rees in 1986, tissue expansion offers another interesting possibility for local coverage. The risk of complications, especially infection, in below-knee tissue expansion is well known, requiring rigorous patient selection based on an evaluation of skin quality, vascularization, and the patient's metabolic and psychologic status. We used this method in 5 patients (3 females, 2 males; mean age 30.4 years) who had been amputated below (n = 4) and above (n = 1) the knee. In 4 cases, amputation of a healthy limb was required after trauma and in 1 case due to purpura fulminans. Seven tissue expanders were used with slow intermittent expansion applied daily. The mean expansion period was 89.4 days. Mean hospital stay for the two operations was 5.66 and 7.33 days, respectively. Assessed on the basis of subjective and objective criteria, functional outcome was excellent in 3 patients and good in one patient. Failure occurred in one case due to infection. Despite the longer treatment period, tissue expansion for skin coverage of defective amputation stumps appears to have several advantages. It is a simple, reliable and reproducible method with a minimal scar area while preserving skin sensitivity. In addition, the length of the tibial shaft can be spared and minimal modifications are needed to fit the prosthesis.