The repair of defects resulting from external hemipelvectomy is challenging, especially when tissues from the thigh, abdomen, and back are insufficient or unavailable for local flaps. This scenario frequently requires free-tissue transfer. The pedicled upper and lower leg in-continuity fillet flap provides coverage of extremely large defects after external hemipelvectomy, without causing donor-site morbidity. A 48-year-old T6 paraplegic man underwent external hemipelvectomy for osteomyelitis and an extensive Marjolin ulcer involving the buttocks, posterior thigh, and trochanteric regions. To repair the defect, a pedicled upper and lower leg in-continuity fillet flap with a total surface area of 1155 cm2 was used, supplied by the external iliac vessels. Over 95 percent of the flap area was required for the reconstruction, and flap necrosis did not occur. The pedicled fillet flap is an attractive option for repairing massive defects when the lower extremity is to be amputated. This technique can be used to repair defects of the lower trunk without the need for vascular anastomoses and without incurring donor-site morbidity. The oncologic safety of using ipsilateral lower extremity tissue must be considered in each case.
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