Successful preservation of below-knee amputation stump wound with vastus lateralis anterolateral thigh flap in a patient with peripheral artery disease.

The preservation of a below-knee amputation (BKA) stump is essential for maintaining optimal limb function and facilitating future prosthetic use. Salvaging an infected stump is particularly challenging due to the loss of healthy soft tissue necessary to preserve adequate limb length. Patients with peripheral artery disease are often not considered candidates for complex reconstruction given concerns for poor perfusion, active smoking, and medical comorbidities. This case demonstrates a patient who underwent a BKA after failed revascularization for acute limb ischemia. Successful salvage of a BKA stump with a polymicrobial infection was achieved using an anterolateral thigh free flap with vastus lateralis muscle. At 4 months postoperatively, the patient was successfully ambulating with a prosthetic leg. This case demonstrates that advanced reconstruction for preservation of BKA stump may be feasible in patients with underlying peripheral artery disease.