PMC3924016_01
A 66-year-old man who had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome and an extensive soft tissue defect of the left leg. (A) Lateral view of the left leg at 47 days after the initial fibular free flap transfer. The skin incisions were performed along the dashed lines. (B) Intraoperative view after tibial osteotomy and flap elevation. (C) Immediate postoperative appearance after below-knee amputation and wound coverage with a nonisland pedicled foot fillet flap. (D) Follow-up view at 7 months after below-knee amputation and flap coverage. The flap was well healed with improving sensation to the skin flap and the patient was satisfied with the result.
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The dorsum of the foot was incised from the distal margin of the wound near the lateral ankle to the wound at the dorsum of the foot (Fig. 1A). The intrinsic muscles of the foot were preserved, and the posterior tibial neurovascular bundle was not debulked (Fig. 1B). After insertion of suction drainage tubes, the flap was sutured to the wound and remaining flap margins (Fig. 1C). Follow-up at 7 months after below-knee amputation and nonisland pedicled foot fillet flap showed that the flap was well healed with improving sensation to the skin flap and the patient was satisfied with the result (Fig. 1D).