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.
KEYWORDS
Below-knee amputation - TAP flap - fasciocutaneous free flap
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