|| FIG. 25-07. Late follow-up. The patient has protective sensation over the stump surface, and with his prosthesis has won the "High Altitude Run" in Colorado.
A patient sustained an avulsive amputation of the left lower extremity, with loss of the fibula and all soft tissue circumferentially around the knee. (From Hall, E.J., and
Buncke, H.J.: Microsurgical techniques to reconstruct irreparable nerve loss. Orthop. Clin. North Am. 12:381, 1981.)
25-08. The below-knee amputation stump was covered with unstable split-thickness
skin grafts. An above-knee amputation was considered until a microvascular
transplant was suggested. The pattern of the proposed tensor fascia lata
flap is next to the leg.
FIG. 25-09. The pattern has been transferred to the lateral aspect of the contralateral thigh and hip, outlining a massive flap 42 cm long by 15 cm wide.
FIG. 25-10. The tensor fascia lata myocutaneous flap has been elevated, preserving the lateral femoral cutaneous nerve entering the anterior portion of the flap and slips from T-12 entering the posterior upper border of the flap.
FIG. 25-11. The 42 x 15 cm flap has been completely wrapped around the amputation stump and sutured in place, anastomosing the vessels of the tensor fascia lata flap to terminal branches of the popliteal vessels. The lateral femoral cutaneous nerve was anastomosed to the posterior nerve at the thigh, and the terminal branches of T-12 to branches of the saphenous nerve on the medial aspect of the knee.
FIG. 25-12. The tensor fascia lata flap is in place. The bulkiness in the popliteal fascia was thinned at a subsequent procedure to prevent pinching of this tissue by the prosthesis.
FIG. 25-13. The massive donor site is well covered with split-thickness skin grafts. Closure of this donor area under tension can produce circulation problems in the thigh and leg.
FIG. 25-14. The patient had many problems with prosthetic fittings and stump adjustments.
FIG. 25-15. Despite the problems, he has continued to be active and mobile.
A patient had an avulsive injury of the left heel following a motor vehicle accident.
FIG. 25-16. Extent of injury.
FIG. 25-17. A large tensor fascia lata flap is elevated on the ipsilateral hip.
FIG. 25-18. The medially entering pedicle is visible with the flap reflected medially.