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RACS ASC 2026
A Decision-Based Framework for Reconstruction of Traumatic Lower-Limb Amputations Using Salvaged Tissue
Verbal Presentation
Presentation Description

Institution: Westmead Hospital - NSW, Australia

Purpose: Despite advancements in reconstructive techniques, lower limb amputations remain a common outcome of lower limb trauma. The primary aim of amputation is to create a functional, sensate, and pain-free stump whilst preserving maximal limb length possible. The foot is a valuable source of tissue that is frequently distal to the zone of trauma and is otherwise discarded in traditional amputations. It offers robust, sensate and well-vascularised coverage for amputation stumps. Key options include the fillet-of-sole flap, which consists of the durable glabrous skin, plantar muscles, and fascia, and the complementary dorsal foot flap, made of soft tissue from the dorsal foot. While these flaps have been described in the literature, their application remains underutilised and there exists no established decision-making framework for these flaps in the context of leg amputation. We present our experience with the 'spare-parts' concept in lower limb reconstruction through an illustrative case series and propose an algorithm aimed at optimising residual limb length and sensibility. Methodology: A retrospective, multi-centre review was conducted across three tertiary hospitals on patients who underwent lower limb amputation stump reconstruction using salvaged tissue from 2022 to 2024. Results: Three male patients, aged 20-27, were included: one with an above-knee amputation and two with below-knee amputations due to motor-related trauma. One free and three pedicled fillet-of-sole flap reconstructions were performed. All flaps remained healthy and sensate throughout the follow-up period. Based on these cases, a pragmatic decision-making algorithm was developed to guide management in future presentations. Conclusion: Foot flaps are a viable option for reconstructing traumatic lower limb amputations. Developing a protocol based on vascular integrity and zone of trauma can improve outcomes by tailoring techniques to specific clinical situations.
Presenters
Authors
Authors

Dr Brandon He - , Dr Hardip Chahal - , Dr Gehan Karunaratne - , Dr Pratik Rastogi - , Dr Tim Wang - , Dr Varun Harish - , Dr Bish Soliman -