Microsurgical Calcaneus Osteocutaneous Fillet Flap for Below-Knee Amputation Salvage: A Case-Based Surgical Technique with Long-Term Outcomes

Traumatic amputations and non-reconstructable sub-amputations with soft-tissue loss of the lower limb are highly disabling events. The calcaneus osteocutaneous fillet flap should be considered in lower leg amputations and non-reconstructable sub-amputations to preserve length and convert an above-knee amputation to a below-knee amputation without further donor site morbidity. Preserving the knee joint in an amputated limb is associated with faster rehabilitation and a quicker, more natural gait. Some complications can occur and must be appropriately managed during the postoperative days and the following months. This report presents a case of a fillet flap successfully performed in a young woman, with an extended 6-year follow-up. Three consecutive complications, i.e., osteosynthesis revision, painful saphenous nerve amputation neuroma, and surgical scar dehiscence, were successfully managed in the postoperative weeks. At 6 years from injury, the patient had a physiological gait and walked a distance of 200 m in 2 min without shortness of breath. She scored optimally (82 out of 100 points) in all the items of the Short-Form Health Survey SF-36 test (compared with the standard scores for below-knee amputated patients). She scored 63 out of 80 on the Orthotics and Prosthetics User's Survey (OPUS) test. No further revision surgery was necessary. No sensory disturbances persisted after the first year from the trauma. The patient reported occasional mood swings coinciding with episodes of phantom limb pain that continued throughout the years and needed painkillers.