Avoiding the Dreaded Amputation

Definitive amputation for recalcitrant full thickness surgical wounds is a dreaded complication, defining surgical failure. Over the past decade, orthoplastic reconstruction techniques have continued to gain popularity and acceptance.

In their article, "A Retrospective Look at Integrating a Novel Regenerative Medicine Approach in Plastic Limb Reconstruction,” Rodriguez Collazo et al. described a novel technique for limb salvage in patients recommended lower extremity amputation.

The technique

• Hemi-soleus and/or peroneus brevis muscle flap

• Concentrated bone marrow aspirate and platelet rich plasma

• Dermal wound matrix with wound a VAC-assisted closure for 2-3 weeks

• Split-thickness (0.018) skin graft

• External fixation for 8 weeks

Outcomes

Seventeen patients failed treatment for more than 11 months and were recommended definitive amputation. Four patients had active infection and were on systemic antibiotics. The average defect size was 19.6cm2.

All but one patient successfully achieved limb salvage; definitive amputation was performed for muscle necrosis secondary to compartment syndrome.