Double flap from amputated opposite lower limb for cover of plantar and dorsal surfaces of a crushed foot
A 45 year old male patient who was run over by a train resulting in a right leg amputation at the level of the knee and a crush injury of the left foot. He was brought to our hospital about 2 h after the accident. The right lower limb had a severe comminution and bone loss at the knee joint, with the loss of skin and soft- tissue and crushing of muscle above and below the knee [Figures and ]. The left forefoot was completely degloved and all the toes were crushed and degloved as well [Figures and ].\nThe right lower limb was deemed not replantable as the knee joint was severely damaged and not salvageable, In addition, debridement of crushed and devitalized tissues would result in a 15-20 cm shortening and a limb that was at least 15 cm short with fused knee joint would not be functionally useful and primary insertion of prosthetic knee joint was not considered to be feasible by the attending orthopaedic surgeon.\nFocus was then shifted to the crushed left foot with a view to perform immediate debridement and early soft-tissue cover, to salvage as much of the foot as possible and get it fully healed and weight bearing at the earliest. Stable and sensate skin cover were vital, as this would be the only surviving foot. A large defect such as this would require a large distant flap or even two flaps. Best replacement for skin on the foot was anatomically identical skin from the opposite foot, which in this case was provided by the well-preserved amputated limb. The general condition of the patient was stable and he had no other life-threatening injuries. Immediate double free tissue transfer from the amputated limb was done. A plantar flap based on the posterior tibial vessels [] and a dorsal flap based on the dorsalis pedis vessels [], with the communication between the dorsal and plantar systems left intact through the deep branch of the 1st dorsal metatarsal artery. Satisfactory inset of dorsal flap [], and of plantar flap [] was achieved. Post-operatively the patient developed a hematoma below the dorsal flap. Since flaps were harvested from the amputated limb, small blood vessels that could not be seen were probably left unligated. Re-exploration and evacuation of hematoma was performed. Both flaps survived completely [Figures and ].