SALVAGE OF FOOT AMPUTATION STUMPS OF CHOPART LEVEL BY FREE MEDIAL PLANTAR FLAP

Blast energy-induced traumas usually result in some type of amputation s of lower extremities. It is very hard to determine the amputation le vel of the feet of these cases at first, and secondary amputation stum p revisions by bone shortening are often necessary. Among partial foot amputation levels, Chopart level is the most critical. Four male pati ents (20 to 24 years old)with modified Chopart amputation due to mine explosion injury have had skin-grafted amputation stumps where trouble some, recurrent unstable wounds had developed. These amputation stumps were electively reconstructed with neurosensorial free medial plantar flaps from unaffected feet without any bone shortening. All the trans ferred flaps survived and adapted to stumps well, and patients were am bulated at the second month by wearing on the original prosthesis afte r minimal adjustments. At the follow-up period (6 months to 2 years), no skin breakdown of the stumps was evident. Monofilament (Semmes-Wein stein) tests revealed diminished light touch in two patients and dimin ished protective sensation in another two patients at the sixth month. Temporary donor foot pain, which existed by walking for 3 months, may be due partly to absence of plantar fascia supporting the plantar are . We suggest that amputation level of Chopart is the most critical of partial foot amputations in young patients and should be reconstructed with flaps if there is not sufficient soft-tissue coverage of amputat ion stump; free neurosensorial medial plantar flap would be the primar y choice with its advantages.