J Reconstr Microsurg 2004; 20(8): 605-609
DOI: 10.1055/s-2004-861518
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Thoracodorsal Artery Perforator (TAP) Flap Reconstruction of a Soft-Tissue Defect of the Knee Following Below-Knee Amputation

Amanda J. Fortin1 , Roman J. Skoracki2
  • 1Section of Plastic Surgery,University of Manitoba, Winnipeg, Manitoba, Canada
  • 2Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, Texas
Further Information

Publication History

Publication Date:
03 January 2005 (online)

ABSTRACT

Soft-tissue coverage of lower extremity defects with thin, sensate, mobile, and durable soft tissue is challenging. Reconstructive options are further limited in the setting of a below-knee amputation. The authors present the first report of an innervated thoracodorsal artery perforator (TAP) flap for coverage of an anterior knee soft-tissue defect in a patient with bilateral below-knee amputations following disseminated meningococcemia. The soft-tissue defect measured 11 × 17 cm2 centered over the patella, and the TAP flap provided adequate pedicle length, with optimal soft-tissue thickness and pliability with the potential for innervation and minimal donor-site morbidity. Six months postoperatively, the patient is ambulating well with prostheses fitted over her well-healed, stable, knee coverage.

REFERENCES

  • 1 Nahabedian M Y, Orlando J C, Delanois R E, Mont M A, Hungerford D S. Salvage procedures for complex soft tissue defects of the knee.  Clin Orthoped Rel Res. 1998;  356 119-124
  • 2 Yuen J C, Zhou A T. Free flap coverage for knee salvage.  Ann Plast Surg. 1996;  37 158-166
  • 3 Yuen J C. Free-muscle-flap coverage of exposed knee joints following fulminant meningococcemia.  Plast Reconstr Surg. 1997;  99 880-884
  • 4 Gallico III G G, Ehrlichman R J, Jupiter J, May Jr J W. Free flaps to preserve below knee amputation stumps: long term evaluation.  Plast Reconstr Surg. 1987;  79 871-878
  • 5 Gonzalez E G, Corcoran P J, Reyes R L. Energy expenditure in below-knee amputees: correlation with stump length.  Arch Phys Med Rehab. 1974;  55 111-119
  • 6 Chicarilli Z. Free-flap salvage of a traumatic below-knee amputation.  Plast Reconstr Surg. 1987;  79 968-973
  • 7 Gooden M A, Gentile A T, Mills J L et al.. Free tissue transfer to extend the limits of limb salvage for lower extremity tissue loss.  Am J Surg. 1997;  174 644-649
  • 8 Shenaq S M, Krouskop T, Stal S, Spira M. Salvage of amputation stumps by secondary reconstruction utilizing microsurgical free-tissue transfer.  Plast Reconstr Surg. 1987;  79 861-870
  • 9 Schwabegger A J, Bodner G, Ninkovic M, Piza-Katzer H. Thoracodorsal artery perforator (TAP) flap: report of our experience and review of the literature.  Br J Plast Surg. 2002;  55 390-395
  • 10 Fisher S V, Gullickson Jr G. Energy cost of ambulation in health and disability: a literature review.  Arch Phys Med Rehab. 1978;  59 124-133
  • 11 Kim J T, Koo B S, Kim S K. The thin latissimus dorsi perforator-based free flap for resurfacing.  Plast Reconstr Surg. 2001;  107 374-382

Roman J SkorackiM.D. 

University of Texas M.D. Anderson Cancer Center, Department of Plastic Surgery

Unit 443, P.O. Box 301402, Houston, TX 77230