Free fillet lower leg flap for coverage after hemipelvectomy or hip disarticulation

Orthop Traumatol Surg Res. 2019 Feb;105(1):47-54. doi: 10.1016/j.otsr.2018.10.018. Epub 2018 Dec 27.

Abstract

Introduction: Tumor resection is the gold standard treatment for soft tissue and bone sarcomas. In the pelvis, this may require a hemipelvectomy that can compromise primary skin closure. Flaps are essential in this context; however the vascularization of potential pedicled flaps may have been removed during tumor excision. Using healthy tissue from the amputated limb as a free flap is an excellent coverage option.

Hypothesis: The free fillet flap from an amputated lower limb is a simple and reliable coverage technique after hemipelvectomy or hip disarticulation.

Material and methods: Seven patients were operated on at three specialty centers: six transpelvic amputations (external hemipelvectomy) and one hip disarticulation. In three cases, the flap consisted of the superficial posterior compartment of the calf area and in the three other cases, the lower leg compartments with the fibula and its intact periosteum. Complications were documented.

Results: Clear resection margins were achieved in all patients. The mean follow-up at the final visit was 13 months (range, 6.5 to 21 months). Six patients had complications but only one resulted in loss of the flap. Four patients were able to be fitted with a hip prosthesis.

Discussion: The free fillet flap from an amputated lower limb is a reliable coverage technique (86%) after hemipelvectomy or hip disarticulation. In the 16 cases previously reported in the literature, there were no wound-healing failures. Local flaps are often too fragile with insufficient muscular padding. This free flap is the preferred first-line technique as it spares other potential free flaps in case of failure without increasing the morbidity of a procedure that is already extensive. This coverage technique should be one the options considered after external hemipelvectomy.

Level of evidence: IV, retrospective study.

Keywords: Fillet flap; Free leg flap; Hemipelvectomy; Hip disarticulation; Spare part concept; Transpelvic amputation.

MeSH terms

  • Adult
  • Arthroplasty, Replacement, Hip / methods*
  • Bone Neoplasms / surgery*
  • Disarticulation / methods*
  • Female
  • Free Tissue Flaps*
  • Hemipelvectomy / methods*
  • Humans
  • Male
  • Middle Aged
  • Osteosarcoma / surgery*
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies