Lower Extremity Fillet Flap With Plantar Skin for Reconstruction of Pressure-Related Ulceration in a Patient With Transverse Myelitis.

Transverse myelitis is a rare, acquired inflammatory neurologic disorder that can result in chronic disability and secondary complications, including decubitus ulcers. These ulcers may serve as portals for infection and can progress to osteomyelitis, particularly when involving high-pressure areas. We present the case of a 45-year-old female with chronic transverse myelitis who developed a stage 4 perineal, ischial, and femoral decubitus ulcer complicated by acute-on-chronic osteomyelitis of the pelvis and femur. The patient underwent a left lower extremity amputation with preservation of the soft tissues as a myocutaneous turn-up fillet flap, which was utilized to reconstruct and cover the extensive ulcer defect covering the chronically exposed femur and pubic rami. Due to its durability and resistance to pressure and shear forces, the plantar skin of the amputated foot was used to reconstruct the ischial region, an area subject to significant mechanical stress. This case highlights a severe complication of transverse myelitis and introduces a novel reconstructive approach using a fillet flap with plantar skin for the coverage of high-pressure decubitus ulcers. Further studies are needed to evaluate long-term outcomes in the potential broader application of this reconstructive technique.