Case 57: An Initially Successful Lengthening of a Traumatic Below Knee Amputation Stump by Ilizarov Technique with Subsequent Failure Due to Soft Tissue Conditions

Abstract

A traumatic below-knee amputation resulted into a too short stump allowing a conventional below-knee prosthesis which decreased gait efficiency. The Ilizarov technique was used on the 24 year old girl to increase tibial length with 5 cm (= + 62 %) at the age of 25 which gave a 13.5 cm stump length, sufficient for a prosthesis. Bony consolidation was successful, but several problems were encountered with the soft tissues. The scarred skin over the distal end of the bony stump ruptured at the end of the distraction period. A free latissimus dorsi flap transfer failed by inadequate blood flow probably by the dystrophic vessels of the stump. Finally a through-knee amputation was needed. This outcome of the stump lengthening might have been avoided by a preparatory plastic surgery including controlled mechanical overstretching of the scarred skin. Soft tissue quality is the most determining factor in the outcome of a below-knee amputation stump lengthening.