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Arch Hand Microsurg > Volume 20(1); 2011 > Article
Journal of the Korean Society for Surgery of the Hand 2011;20(1):51-56.
Published online May 31, 2011.
DOI: https://doi.org/10.12790/jkssh.2011.20.1.51   
Reverse Anterolateral Thigh Flap to Reconstruct a Below-Knee Amputation Stump: Two Case Reports
Duke Whan Chung, M.D., Chung Soo Han, Jae Hoon Lee, M.D.*, Se Hyuk Hong, M.D.*
1Department of Orthopaedic Surgery, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Korea.
2Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Korea. ljhos69@naver.com
  During below knee amputation, the amputation stump must be covered with well-vascularized and sensate soft tissue. Many flaps can be used for this purpose, but available reconstructive options are limited. We performed reverse flow ALT flap elevation on two patients with below knee amputations to reconstruct defects in the stumps.
  The sizes of the defects in the stumps were 4×16 cm and 5×5 cm, respectively. The most distal portion of the defects were located 20 cm and 16 cm lateral to the knee joint in a curve, respectively. The size of the elevated flap was 5×18 cm for case 1 and 18×10 cm for case 2. The respective pivot points of the pedicles were 7 cm and 6 cm above the patella and the respective lengths of the pedicles were 17 cm and 16 cm. In both cases, venous congestion occurred on the second postoperative day and the flap distal to 10 cm or more from below the knee joint was necrotized at the second postoperative week.
  Surgeons should be cautious when using a reverse ALT flap to reconstruct a soft tissue defect located 10 cm or more distal from below the knee joint. Since a pedicle longer than 15 cm may develop partial necrosis of the flap, simultaneous application of antegrade venous drainage is recommended.
Key Words: Amputation stump, Reverse anterolateral thigh flap

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