Open Access
CC BY 4.0 · Arch Plast Surg 2023; 50(05): 501-506
DOI: 10.1055/a-2033-5803
Extremity/Lymphedema
Idea and Innovation

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

Harry Burton 
1   London Reconstructive Microsurgery Unit, Emergency Care and Trauma Division, Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Alexios Dimitrios Iliadis
2   Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Neil Jones 
2   Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Aaron Saini
3   Trauma and Limb Reconstruction Unit, Department of Trauma and Orthopaedics, King's College Hospital Foundation Trust, London, United Kingdom
,
Nicola Bystrzonowski 
2   Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Alexandros Vris 
2   Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
,
Georgios Pafitanis 
1   London Reconstructive Microsurgery Unit, Emergency Care and Trauma Division, Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
2   Limb Reconstruction and Bone Infection Unit, Emergency Care and Trauma Division, Department of Trauma and Orthopaedics, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
4   Department of Medical Sciences, Medical School, University of Cyprus, Nicosia, Cyprus
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Funding None.
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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

osteocutaneous flap - fillet flap - spare-parts surgery - below knee amputation

Authors' Contributions

H.B.: conceptualization, methodology, literature review, writing the original draft, review and editing, project administration. A.D.I.: editing of manuscript. N.J.: editing of manuscript. A.S.: editing of manuscript. N.B.: editing of manuscript. A.V.: editing of manuscript. G.P.: senior author, review/editing manuscript.


Ethical Approval

Not required.


Patient Consent

Patients provided written informed consent for the publication and the use of their images.




Publication History

Received: 18 August 2022

Accepted: 12 January 2023

Accepted Manuscript online:
11 February 2023

Article published online:
24 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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