IDEAS AND INNOVATIONS
Banking a fillet flap to aid in reconstruction following
a hindquarter amputation
Stephanie S. Young
Received: 30 October 2014 /Accepted: 24 May 2015 /Published online: 25 September 2015
Springer-Verlag Berlin Heidelberg 2015
Abstract A hindquarter amputation and hemipelvectomy for
recurrent malignancy presents a reconstructive challenge to
the plastic surgeon. Tumour resection leaves a considerable
defect, with exposure of bone, neurovascular structures, pelvic
and abdominal organs. A free lower leg fillet flap is a
recognised method of providing soft tissue coverage, but isch-
aemic time is often lengthy as described in the literature. We
present a unique method of providing soft tissue coverage
using a free lower leg fillet flap, and minimising ischaemic
time by banking the flap on the ulnar artery during the hind-
quarter amputation and tumour resection.
Level of Evidence: Level V, therapeutic study.
Keywords Fillet flap
Hindquarter amputation and hemipelvectomy for recurrent ma-
lignancy presents a reconstructive challenge to the plastic sur-
geon, with exposure of bone, neurovascular structures, pelvic
and abdominal organs. We present a unique method of reducing
flap ischaemic time when using a free lower leg fillet flap in the
reconstruction of such a defect, following hindquarter ampu-
tation for a fourth recurrence of hemipelvic chondrosarcoma.
A 58-year-old man presented to the sarcoma service with a
fourth recurrence of a grade 2 chondrosarcoma of the left pelvis.
He had previously undergone in separate procedures over
1. Excision of the superior pubic ramus.
2. Excision of the inferior pubic ramus.
3. Resection of the left ischial tuberosity.
4. Left subtotal internal hemipelvectomy, with prosthetic re-
construction of the left hip, cystectomy with ileal conduit
and a defunctioning colostomy. Prostatectomy was car-
ried out for a coincidental prostate cancer. The soft tissue
defect was reconstructed with a right pedicled rectus
abdominis myocutaneous flap.
Staging CT scans were negative. MRI confirmed close
proximity of the tumour to the pelvic veins with a risk of
erosion and fatal intra-pelvic haemorrhage.
The North of England Bone and Soft Tissue Tumour
Service recommended excision given that the tumour was
growing despite radiotherapy, and the poor sensitivity to che-
motherapy that chondrosarcomas display.
Potentially curative surgery necessitated a hemipelvectomy
and reconstruction using a free fillet flap of the leg as com-
bined case with plastic, orthopaedic and general surgery.
With the patient supine and initially under tourniquet control,
the plastic surgical team filleted the left lower leg, with an
anterior midline vertical incision.
The fillet flap was transferred to the right forearm with the
popliteal artery anastomosed to the ulnar artery and the venae
commitantes to the basilic and cephalic veins (Fig. 1,graphic).
* Stephanie S. Young
North of England Bone and Soft Tissue Tumour Service, Royal
Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1
Eur J Plast Surg (2016) 39:213–215