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. 2023 Aug 24;50(5):501-506.
doi: 10.1055/a-2033-5803. eCollection 2023 Sep.

Osteocutaneous Turn-Up Fillet Flaps: A Spare-Parts Orthoplastic Surgery Option for a Functional Posttraumatic Below-Knee Amputation

Harry Burton  1 , Alexios Dimitrios Iliadis  2 , Neil Jones  2 , Aaron Saini  3 , Nicola Bystrzonowski  2 , Alexandros Vris  2 , Georgios Pafitanis  1   2   4
Affiliations

Osteocutaneous Turn-Up Fillet Flaps: A Spare-Parts Orthoplastic Surgery Option for a Functional Posttraumatic Below-Knee Amputation

Harry Burton et al. Arch Plast Surg. .

Abstract

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

Keywords: below knee amputation; fillet flap; osteocutaneous flap; spare-parts surgery.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Clinical ( A ) and radiological ( B ) imaging at admission demonstrating an open proximal tibia fracture with compromised soft tissue envelope ( A ) on a background of chronic osteomyelitis, osteonecrosis, and a pathological tibial fracture ( B ).
Fig. 2
Fig. 2
Pathological tibia bone segment in situ ( A ) and following resection ( B ) of necrotic tibia measuring 22 cm.
Fig. 3
Fig. 3
Below knee amputation (BKA) stump following fillet flap primary closure ( A ), at 3 months ( B ) and at 6 months with prosthesis fitted ( C ).
Fig. 4
Fig. 4
Computerized tomography ( A ) and plain radiographs ( B , C ) at 12 weeks demonstrating bony union.
See this image and copyright information in PMC

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