The Use of the Pedicled Nonislanded Foot Fillet Flap to Avoid an Above-the-Knee Amputation after Trauma

Abstract

Background: Lower extremity trauma can have a devastating effect on the quality of the life of patients. To avoid limb amputation and its associated social stigma, many patients spend years undergoing multiple costly procedures, with prolonged hospital stays, all the while hoping for an elusive limb salvage. People with lower limb amputation experience higher energy requirements for walking, reduced aerobic capacity, and slower walking speeds, when compared with people with normal limbs. A below-knee amputation (BKA) is functionally superior to an above-knee amputation. Methods: Between 2012 and 2023, five patients underwent BKAs with a nonislanded foot fillet flap reconstruction of the BKA stump. Four of these patients had undergone previous multiple procedures in attempts at limb salvage. While two patients had sustained recent trauma, three were operated on electively. Results: All the BKA stumps healed without any complications. Only one patient complained of phantom limb pain. One patient will require the reconstruction of a lateral knee collateral ligament. Conclusions: This case series demonstrates the versatility of the pedicled foot fillet flap in addressing the different complications of lower extremity injury that may result in an unusable limb. The utility of this technique is especially valuable in low-resource settings where the built environment may be unfriendly to nonbipedal ambulation, and an urgent need for a return to economic productivity. Because prostheses are fairly accessible in Kenya, return to ambulation and economic productivity are anticipated following a BKA.