Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury |
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| Authors: | Cengiz A ikel, Fatih Peker, brahim Akmaz,Ersin Ü lkü r |
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| Affiliation: | 1. Department of Plastic and Reconstructive Surgery and Burn Unit, Gülhane Military Medical Academy and Medical Faculty, Haydarpaşa Training Hospital, 81327 Istanbul, Turkey;2. Department of Orthopaedic Surgery, Gülhane Military Medical Academy and Medical Faculty, Haydarpaşa Training Hospital, 81327 Istanbul, Turkey;1. Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China;2. Division of Bioinformatics and Statistics, School of Public Health, National Defense Medical Center, Taipei 114, Taiwan, Republic of China;3. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China;4. Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China;5. Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China;1. Food, Drug and Chemical Toxicology Division, Council of Scientific and Industrial Research-Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, Uttar Pradesh, India;2. Developmental Toxicology Division, CSIR-IITR, Lucknow, Uttar Pradesh, India;3. Pathology Laboratory, CSIR-IITR, Lucknow, Uttar Pradesh, India;4. Mangla Hospital and Research Centre, Bijnor, Uttar Pradesh, India;5. Department of Medical Elementology and Toxicology, Jamia Hamdard, New Delhi, India;1. Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain;2. La Paloma Hospital, Las Palmas de Gran Canaria, Las Palmas, Spain;3. Medicine Department, Hospital Clínico San Carlos, Madrid, Spain;4. Medicine Department, Hospital Universitario del Sureste, Madrid, Spain;5. Health Security Agency, Ministry of Health, Madrid, Spain;1. Department of Plastic and Reconstuctive Surgery and Burnt Unit, University Hospital ‘Río Hortega’, Valladolid, Spain;2. Cardiovascular Surgery Department, University Hospital of Salamanca, Salamanca, Spain;3. Department of Plastic and Reconstructive Surgery and Burnt Unit, University Hospital “Juan Canalejo”, A Coruña, Spain;4. Infectious Diseases Unit, University Hospital Marqués de Valdecilla, Santander, Cantabria, Spain;5. Internal Medicine Department, Hospital “Virgen del Puerto”, Cáceres, Spain;6. Centro de Atención Primaria de Noja, Cantabria, Spain;7. Radiology Department, University Hospital ‘Marqués de Valdecilla’, Santander, Cantabria, Spain;1. Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA;2. Department of Surgery, University of California, Harbor-Los Angeles, Los Angeles, CA |
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| Abstract: | Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level. |
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| Keywords: | Below-knee amputation Lower limb burns |
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