A patient with an above-knee amputation needed a groin flap transplant to accommodate a prosthesis.

FIG. 6-55. The above-knee amputation is through the mid-thigh, with an unstable scar on the posterior medial aspect of the amputation stump.

FIG. 6-56. A large groin flap, raised from the contralateral side.

FIG. 6-57. The groin flap is transplanted into position. It was impossible to rotate an ipsilateral groin flap into the posterior aspect of the lower stump.

FIG. 6-58. The patient is shown standing with his prosthesis. He is a champion one-legged downhill skier.

CASE 12

In this case, the skin graft was made directly on bone in a below-knee amputation. A prosthesis could not be worn.

FIG. 6-59. Split-thickness skin graft directly on bone in the anterior and distal surface of a below-knee amputation stump. A Doppler probe was used to locate the anterior tibial vessels.

FIG. 6-60. Excisional defect created after removing the skin graft. The groin flap is next to the defect.

FIG. 6-61. The groin flap is wrapped over the distal end of the stump, ready for anastomosis to the located anterior tibial vessels.

FIG. 6-62. Well-healed groin flap provides protective cover over the stump.

FIG. 6.63. The below-knee prosthesis is shown, well-fitted and in place.

CASE 13

A nonunited fracture of the tibia was covered by an unstable skin graft. (From Garrett, J.C., Buncke, H.J., and Brownstein, M.L.: Free groin flap transfer for skin defects associated with orthopedic problems of the lower extremity. J. Bone Joint Surg. 60A:1055, 1978.)

FIG. 6-64. Chronic draining wound.

FIG. 6-65. The underlying nonunited fracture. A previous cross-thigh flap had failed to provide stable coverage.

FIG. 6-66. A mobilized groin flap is next to the wound. In this instance, the groin flap vessels will be anastomosed to the anterior tibial vessels as the groin flap spirals around the anterior lateral aspect of the leg.

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