title: Sensate composite calcaneal flap in leg amputation: a full terminal weight-bearing surface-experience in eight adult patients.
abstract: Despite modern reconstruction techniques and replantation, the preservation of a severely traumatised limb, or even a limb affected by a congenital malformation, usually gives poorer functional results compared with amputation and prosthetisation. The aim of this study was to describe a hind foot (including the calcaneum and fat pad) sensate flap with a surface that allows full terminal weight bearing in transtibial amputations in adults. Between June 2007 and September 2008, eight patients underwent leg amputations with a sensate composite calcaneal flap reconstruction of the stump. Patients consisted of four men and four women with a mean age of 46.5 (26-66) years. All amputations were unilateral. The mean follow-up was 28.3 (25-42) months. There were no complications. Calcaneum tibial fusion was observed in all patients in a mean time of 3.5 (3-4) months. A below-knee prosthesis was adapted at 16 weeks postoperatively in all cases, and no need for stump revision occurred in this series during the entire follow-up period. A transtibial amputation covered with a sensate plantar flap preserving the calcaneum was proposed. In theory, the anatomic structures spared in this technique provide a strong, full, weight-bearing terminal surface of the stump that will last a lifetime.
authors.affiliation: , Rua Ana Zorzetto Favaro 18, Residencial Paineiras, Bairro Betel, São Paulo, 13140-000, Brazil, brunolivani@hotmail.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Livani
authors.forename: Gabriel
authors.initials: G
authors.lastname: Castro
authors.forename: Jose Roberto Tonelli
authors.initials: JR
authors.lastname: Filho
authors.forename: Tâmara Ramos
authors.initials: TR
authors.lastname: Morgatho
authors.forename: Mauricio Leal Dias
authors.initials: ML
authors.lastname: Mongon
authors.forename: William Dias
authors.initials: WD
authors.lastname: Belangero
authors.forename: Michael
authors.initials: M
authors.lastname: Davitt
authors.forename: Jose André
authors.initials: JA
authors.lastname: Carvalho