C.

PLATE XXV-4

In this instance, the medial half of the heel and the entire plantar surface of the foot down to the metatarsal heads have been avulsed and the area has been covered with an unstable skin graft fixed to the underlying structures. An innervated tensor fascia lata flap is planned to give protective sensation to the sole of the foot.

A. The exposed incisional defect.

B. View of the tensor fascia lata, looking at the deep surface, with its vascular pedicle coming into the junction of the middle and proximal thirds, the lateral femoral cutaneous nerve on the anterior medial corner, and the nerve to the tensor fascia lata muscle on the posterior superior corner.

C. The flap has been inserted in place with the vessels, arteries, and vein(s) from the flap sutured in an end-to-end fashion to the posterior tibial artery and vein, which were disrupted by the original injury. The posterior tibial nerve has been dissected proximally and the calcaneum branch separated. This branch is anastomosed to the lateral femoral cutaneous nerve.

Clinical Cases

CASE 1

A 33-year-old man suffered an avulsive amputation of his right leg when it was caught in a power take-off of a tractor.

FIG. 25-01. The stump was covered with unstable and contracted scar.

FIG. 25-02. An 18 x 35 cm tensor fascia lata flap was marked on the ipsilateral hip. The medial blood supply from the lateral femoral circumflex artery is marked.

FIG. 25-03. The flap is elevated from inferiorly to superiorly, approaching the medial vascular pedicle which branches from the lateral femoral circumflex artery to reach the flap between the rectus femoris and the vastus lateralis.

FIG. 25-04. The flap is completely elevated.

FIG. 25-05. The flap is next to the excised recipient defect.

FIG. 25-06. The lateral femoral cutaneous nerve was anastomosed to the saphenous nerve in the medial portion of the popliteal fossa to innervate the flap.

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