Traditional Posterior Flap Method

Traditional Posterior Flap Method Surgical Notes (.pdf)

The patient is a 54 year old gentleman who was involved in a motorcycle accident in 2001. He sustained a closed, left distal tibia and fibula fracture that was treated with an open reduction and internal fixation. Unfortunately in the early postoperative period he developed necrosis about the medial skin. The skin broke down and the fracture site and ankle joint became infected. The patient then had hardware removed followed by a rectus flap to cover the defect as well as the spanning external fixator. He underwent multiple debridements and then in February of 2003 underwent retrograde nailing with arthrodesis of his tibiotalar and subtalar joints. The arthrodesis has failed to unite solidly, in spite of bone grafting and treament with a bone stimulator. He walks with a very antalgic gait with only limited ability to weight bear through the heel. The lower leg has approximately 10 degrees of an external rotation deformity. Attempts at loading the mid-foot and forefoot increase his ankle and high-foot pain, which is localized distinctly to the ankle and hind-foot area. He has a very dysfunctional foot that hurts all the time. He has required both short and long acting narcotic pain medication.

He was referred by his orthopaedic surgeon to our amputee clinic for consideration of left below-knee amputation. This injury and the multiple attempts at arthrodesis have significantly limited his lifestyle. He has pain with standing and walking, and has not been able to return to work. He wants to proceed with below-knee amputation in hopes of improving his function and returning to his previous occupation as a mechanic on an assembly line.

*shorter segments of this video are linked below

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Isolated Clips and Notes

Extended Posterior Flap Method with Bone Bridging

Extended Posterior Flap Method with Bone Bridging Surgical Notes (.pdf)

This is a 33 year old man who sustained a 500lb crush injury to his left foot approximately four years previously. He has chronic pain and dysfunction after several reconstructive surgeries and has requested amputation.

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Isolated Clips and Notes

Extended Posterior Flap Method

An extended posterior flap method transtibial amputation video from a lecture given by Dr. Douglas Smith