Reconstruction of Major Lower-Extremity Amputation Stump with A Free Latissimus Dorsi Flap

Insufficient local soft-tissues for major lower-limb amputation stump coverage due to open fracture, tumor resection and infection are challenging for recontruction. Secondary scar tissue tightness or fistulation may require soft-tissue reconstruction. The authors aimed to assess the long-term outcomes of free latissimus dorsi flap reconstruction for these indications. The authors retrospectively reviewed patient records and identified 20 cases of transtibial amputation stumps reconstructed with free latissimus dorsi flap. The primary outcome was rehabilitation as prosthesis user. Secondary outcomes were scores in the Prothesis Evaluation Questionnaire (PEQ) and comparability of the 15D health-related quality of life (HRQoL) to an age standardized general Finnish population (n=1084). Inclusion criteria were transtibial amputation stump reconstruction with free latissimus dorsi flap and a minimum follow-up of 24 months. Participants in the cross-sectional patient-reported outcome measurement provided their written consent and completed all items in the questionnaires. All patients (n=20) rehabilitated as transtibial prosthesis users. Ten patients completed the outcome measures. The results of the PEQ instrument showed a mean score of 63 (standard deviation, 15) out of 100 points. Patients’ mean HRQoL index was lower than that of the Finnish general population (0.898 vs 0.937). The present study showed that patients with an insufficient amount of local soft-tissues for transtibial amputation and sequelae of complications such as fistulation, scar tension and stump wound can be successfully reconstructed with the free latissimus dorsi flap to salvage the stump. All patients in the study rehabilitated to prosthesis users. The long-term outcomes are encouraging even though some limitations were noticed.