Reconstruction of Soft Tissues of the Postamputation Lower Leg Stump with a Free Anterolateral Thigh Flap for Optimal Prosthesis
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Summary: Patients without proper covering of the bone stump with soft tissues after below-knee amputation have limited opportunities for prosthesis. The resulting high degree of disability severely restricts their proper functioning in social and professional life. The commonly used significant reduction of the bone length for local coverage limits rehabilitative options to the less comprehensive prosthesis. We aimed to describe a delayed reconstruction with soft tissues of the lower leg stump using free anterolateral thigh flap as an alternative surgical method allowing for optimal prosthesis. A 20-year-old patient was consulted because of right lower leg stump, covered only with a skin graft following posttraumatic amputation. Previously, the patient had ineffective attempts of using a prosthesis. He asked to determine the possibility of recovering the functionality of the lower limb. We performed reconstruction of soft tissues of the stump with a free anterolateral thigh flap. Postoperatively, the patient achieved good coverage of the remaining part of the tibia with a thick layer of soft tissues, allowing the subsequent adequate forming of the stump. Therefore, a fixed prosthesis with the dynamic foot could be implemented. A significant increase in physical activity contributed to a full return to the patient’s professional and private life. In conclusion, the free anterolateral thigh flap provides a robust amount of good-quality tissues for supportive function of the lower limb stump. The resulting adaptation of the stump to numerous modern prosthetic devices significantly increases the range of physical activity and contributes to the full return of the patient to their professional and private life.Keywords:
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We report on 162 patients with one- or two-sided amputations above the ankle joint. Seventy-nine percent of these patients were candidates for artificial limbs; substantial differences are shown in respect to the height of the amputation: there are considerably more patients who can use a prosthesis after a lower leg amputation than after one- or two-sided upper leg amputation. Counterindications for prostheses were, on the whole, principally arterial scleroses. As expected, almost 95% of the one-side amputees, and approximately 100% of the (considerably younger) both-side amputees were discharged from hospital with a degree of self-sufficiency. Some of the patients not provided with an artificial limb were able to return home as well (87.5%). Absolute independence was seldom reached and social assistance had to be arranged for many amputees.
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Abstract Mangled extremities are a challenging problem for the orthopaedic surgeon. The decision for salvage versus amputation is multifactorial. Several work groups have attempted to create scoring systems to guide treatment, but each case must be regarded individually. As surgical technique and prosthetics continue to improve, amputations should be seen as a viable reconstructive option, rather than failure. This article reviews scoring systems for the mangled extremity, outcomes on salvage versus amputation, amputation surgical technique, and prosthetic options.
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Journal Article Prostheses and Rehabilitation after Arm Amputation Get access Prostheses and Rehabilitation after Arm Amputation. By Bender LFSpringfield, Charles C Thomas, Publisher, 1974, cloth, 179 pp, illus, $12.50. Joan E. Edelstein Joan E. Edelstein Search for other works by this author on: Oxford Academic Google Scholar Physical Therapy, Volume 55, Issue 6, June 1976, Page 687, https://doi.org/10.1093/ptj/55.6.687 Published: 01 June 1975
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To illustrate what I have to say, it will be best to take one of the cases in which this mode of treatment was carried out.But it should perhaps be premised that the mode of treatment suggested is only to be used where all other ordinary methods have failed.Thus it is not meant to take the place of the ordinary treatment of hip-joint disease by prolonged rest, by erasion, or excision.It is, however, meant as an alternative mode of treatment to amputation at the hip-joint, where excision has been tried and has failed, or where the patient's serious I For much kind assistance in looking up these cases I am indebted to Mr.
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Our purpose in this paper is to report a study of seventy cases of amputation of the lower extremity. We will present the causes for amputation and the treatment received, as well as the present appearance and function of the amputation stumps. This entire subject received great emphasis after the World War, at which time it has been estimated that more than one-half million amputations were done. Surgeons began analyzing their cases, and closer contact with the prosthesis makers emphasized many practical phases of the problem. As a result the rather well defined rules for stump lengths have been repeatedly stressed. This study will show that if these rules are violated reamputation frequently becomes necessary. During the past nine years in the orthopedic service at the State University and Crippled Children's hospitals there have been more than 250 amputations, and for our follow-up study seventy patients returned. The average follow-up
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Abstract A study of 169 unilateral amputees under three Disablement Services Centres was performed. The study comprised 88 above-knee, 54 through-knee and 27 Gritti-Stokes amputations. Satisfactory rehabilitation occurred in 33 per cent of above-knee, 62 per cent of through-knee and 44 per cent of Gritti—Stokes patients (56 per cent overall). The better rehabilitation of through-knee versus above-knee amputees (P < 0·02) was also found in a group of patients matched for comparable age and duration of amputation as well as in a group of age-matched vascular amputees. Through-knee amputees relied significantly less on wheelchairs than above-knee (P = 0·016) and Gritti—Stokes (P = 0·05) amputees. The prosthesis used for the through-knee and Gritti—Stokes amputations was considered unsightly in 50 per cent of cases (versus 31 per cent for the above-knee prosthesis). The superior rehabilitation with through-knee amputations should prompt us to improve both our technique for this amputation and the prostheses currently available. A through-knee amputation should be performed in preference to an above-knee amputation in the case where either is surgically possible, and a below-knee amputation not feasible.
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In order to review major lower extremity amputations at the Toronto East General and Orthopaedic Hospital Inc. between 1979 and 1984, 60 patients with 42 below-knee, 17 mid-thigh and 20 Callander through-knee amputations were studied retrospectively. The three amputation groups demonstrated comparable rates of stump healing. A previous history of vascular surgery on the extremity increased the risk for both delayed healing and failure to heal. The Callander through-knee amputees were rehabilitated earlier and more easily than were the mid-thigh amputees, and once rehabilitated they were more likely to continue using their prostheses. The authors recommend that, when possible, the chosen site of amputation for the majority of patients should be below the knee, but when this is not practical a through-knee amputation should be done in preference to a mid-thigh amputation.
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The gluteal thigh flap is a myofascio-cutaneous flap receiving its blood supply from a descending branch of the inferior gluteal artery. The gluteal thigh flap was first described by Hurwitz in 1980; since then numerous articles have reported on the successful use of this flap, as a transposition or a pedicled island flap, to cover wounds in the sacrogluteal and perineal regions. In contrast to its widespread use as a pedicled flap, employment of the gluteal thigh flap as a free flap is almost unreported in the literature, despite its extremely low donor morbidity and numerous articles on successful (other) free flap reconstructions based on the (same) inferior gluteal artery (e.g., in breast reconstruction). In this article we report on the successful use of the gluteal thigh flap as a purely fascio-cutaneous free flap in limb reconstruction. The literature on the microvascular anatomy of the gluteal thigh flap is reviewed in detail, and a precise description is given of the preoperative measures and surgical manoeuvres required to increase the reliability of this free flap. From the anatomical data and the problems encountered in this case, it should be concluded that, despite the many advantages of this flap and an ultimately successful outcome, the gluteal thigh flap is not a first choice flap for microvascular transfer. © 1997 Wiley-Liss, Inc. MICROSURGERY 17:386–390 1996
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Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions.
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