A lower-extremity fillet flap prepared from a nonfunctional limb provides a viable reconstructive option for patients suffering from complex stage IV pressure sores, according to clinical findings published in the Annals of Plastic Surgery. Surgeons utilizing this technique can close large, complicated wounds—including those complicated by osteomyelitis—while removing the physical burden of a nonfunctional organ that restricts patient mobility.
Clinical Application of Lower-Extremity Fillet Flaps
According to research detailed in the February 2024 issue of Annals of Plastic Surgery (Vol. 92, Issue 2, pp. 230-239), a study led by Aydın Turan evaluated the use of lower-extremity fillet flaps in five patients with complex stage IV pressure ulcers. The patient cohort had a mean age of 60 years, with an average follow-up period of 18 months. To create the flaps, surgical teams performed iliofemoral disarticulation on nonfunctional lower extremities that presented with multiple lesions.
The procedure serves a dual purpose in advanced wound management. By harvesting tissue from a paralyzed or nonfunctional limb, clinicians eliminate excess weight that typically hinders patient transfers and positioning. Furthermore, specific components of the harvested tissue can address vulnerable anatomical sites. In the study, a plantar flap was utilized in one patient for prophylactic padding of the lumbosacral region, while another patient received a plantar flap designated as a sensate flap.
Postoperative Outcomes and Mobility Recovery
Postoperative results indicated no major complications, such as total or partial flap necrosis, across the patient group. Minor complications were limited to a single instance of a sub-flap hematoma that resulted in wound dehiscence; however, this resolved uneventfully without compromising the primary flap, according to the published data. Although patients experienced minimal loss of pelvic stability and balance stemming from the iliofemoral disarticulation, these changes did not interfere with their baseline sitting ability.
By removing the physical dead weight of nonfunctional legs, all five patients achieved increased daily activity and mobility. The structural adjustments allowed individuals to perform routine tasks independently, including turning in bed, utilizing a wheelchair, eating, and dressing. Clinical follow-ups confirmed no recurrence of pressure sores in any of the patients during the observation period. Additionally, the patient who received the sensate plantar flap for lumbosacral padding demonstrated sensory recovery, reporting the perception of touch over the flap by the fifth postoperative month.
Reconstructive Implications for Paraplegic Patients
The findings build upon established concepts in microsurgery and flap reconstruction, such as previous studies published in Chirurg and Plastic and Reconstructive Surgery regarding sensate free flaps for sacral defects. When traditional local flaps fail or are unavailable due to the severity and chronicity of stage IV ulcers, utilizing a fillet flap from an amputated or nonfunctional limb offers a durable alternative. Authors of the study conclude that the technique successfully prevents ulcer recurrence while substantially improving the functional quality of life for individuals with severe mobility impairments.
Worth a look