BACKGROUND & PURPOSE:  Forequarter and hind limb amputations are used for curative and palliative intents in the setting of proximal limb, thorax, or truncal malignancies.  The distal portions of these limbs can be harvested as fillet flaps, and represent the “spare parts” concept of surgical reconstruction.  The purpose of this study was to evaluate the efficacy of our experience with coverage of these large defects by using the free fillet extremity flap.
PATIENTS & METHODS:  A retrospective review was performed of 27 patients (22 men, 5 women) who had undergone immediate reconstruction with free fillet extremity flaps between 1990 and 2008. The mean age was 52.4 years. Seventeen patients received preoperative radiotherapy, and 22 received preoperative chemotherapy. Resections were curative in 5 and palliative in 22 (secondary indications included pain, necrosis, pathologic fracture, exposed vital structures, and infection), and included hemipelvectomies (7), forequarter amputations (16), and hindquarter amputations (4).  Mean defect size was 1111cm² (range, 525 cm² to 3500 cm²).  One flap included the fibula for pelvic stabilization; six flaps included lower leg fascia for abdominal hernia repair; five flaps also incorporated synthetic or bioprosthetic mesh for composite reconstruction. 
RESULTS:  There were no flap losses.  Two flaps required operative debridement for partial flap necrosis.  All wounds healed.  The mean follow-up time was 15 months.  Eight patients are alive, one patient was lost to follow-up, and the remaining 18 patients died within 22 months of reconstruction.  There were twelve known recurrences, but none were noted within the fillet flap.  At the time of discharge from the hospital, pain, tissue necrosis, and infections were improved in all patients. Although phantom pain occurred in 11 patients, it seemed more tolerable than the original cancer pain.  Overall quality of life was improved, as evidenced by the patients’ resumption of activities of daily living.
CONCLUSION:  Extensive and complex defects can be reconstructed successfully with the use of the free filet extremity flap. Appropriate advanced preoperative and intraoperative planning is essential. This procedure is oncologically sound, has no associated donor sites, has an acceptable incidence of major complications (7 percent), and allows for a healed wound with an improvement in the quality of life.  This is the largest series of free fillet flaps published in peer-review literature.