The Functional Benefits of Preserving the Proximal Lower Leg Even in Total Necrosis of the Lower-Leg Muscles

Itaru Tsuge, MD, PhD; Michiharu Sakamoto, MD, PhD; Jun Arata, MD; Naoki Morimoto, MD, PhD


ePlasty. 2020;20(ic12) 

In This Article


A 43-year-old man was introduced to us for the treatment of an infected wound after below-knee (B-K) amputation (Figure 1). Four months previously, he had experienced sudden cardiogenic shock and was transferred to the emergency department of another hospital. Under a diagnosis of fulminant myocarditis, percutaneous cardiopulmonary support (PCPS) from the right femoral artery was applied. His general condition gradually improved; however, PCPS caused right lower-limb ischemia and resulted in B-K amputation. After surgery, severe infection occurred and above-knee (A-K) amputation was recommended for an early cure. At the first visit to our hospital, contrast computed tomographic scan showed fluid accumulation at both the posterior and anterior tibias (Figure 2). We opened the scar and found that the ulcer had reached the popliteal fossa, with a large amount of yellow discharge. All of the lower-leg muscles, including the gastrocnemius and soleus muscles, were necrotic and were removed (Figure 3).

Figure 1.

Preoperative findings. The black arrow indicates an ulcer on the right lower leg.

Figure 2.

Contrast computed tomographic scan shows fluid collection in both the posterior segment (white arrow) and the anterior segment (white arrowhead).

Figure 3.

Intraoperative findings. The soleus and gastrocnemius muscles are necrotized with infection.