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Malagón P, Taghizadeh R, Torrano L, González J. A new protocol for improving immediate monitoring of skin-island free flap with near-infrared spectroscopy and ultrasound. J Plast Reconstr Aesthet Surg 2023; 83:334-342. [PMID: 37300973 DOI: 10.1016/j.bjps.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Postoperative monitoring is essential for detecting early complications and improving the salvage rate of free flaps. We propose a new protocol for free flap monitoring based on the combination of near-infrared spectroscopy (NIRS) and ultrasound. METHODS All free flaps with a skin paddle were included and divided into two groups according to the immediate postoperative monitoring method used: ultrasound examination (control group) or those monitored using our protocol (study group). The number of surgical revisions, intraoperative findings, immediate flap failure, sensitivity, and specificity were compared between the two groups. RESULTS A total of 221 free flaps performed in 209 patients were included. The NIRS automatically detected vascular compromise in 21.8% of cases. A complication was confirmed in half of these cases by ultrasound examination, and surgical reintervention was indicated (10.9%), even in the absence of clinical changes in the skin paddle. In all the surgical revisions, the complication was confirmed, and there was no flap necrosis in the non-revised cases. The salvage rate for revised flaps and the flap survival rate were higher in the study group (salvage rate: 25% vs 72.7%; survival rate: 92.5% vs 97%). A sensitivity of 100% and a specificity of 100% were found for the combination of both monitoring methods. CONCLUSION The proposed protocol is a non-invasive and reliable method for early identification of postoperative complications of free flaps that allows higher rates of salvage rate and reduces the need for specific staff with continuous on-site presence for flap monitoring.
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Affiliation(s)
- Paloma Malagón
- Department of Plastic Surgery, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Rieka Taghizadeh
- Department of Plastic Surgery, St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, UK
| | - Laura Torrano
- Department of Plastic Surgery, Hospital de la Sant Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Jeong SH, Baik SH, Namgoong S, Dhong ES, Han SK. An algorithmic approach to soft-tissue reconstruction around the knee using anterolateral thigh perforator flap in patients with post-traumatic knee osteomyelitis. Front Surg 2023; 10:982669. [PMID: 36814861 PMCID: PMC9939455 DOI: 10.3389/fsurg.2023.982669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023] Open
Abstract
Background Free tissue transfer to the knee region in patients with chronic post-traumatic knee osteomyelitis (CTKOM) poses a great challenge to surgeons because the remaining soft tissues adjacent to defects, including vascular structures, are usually damaged by chronic inflammation and multiple debridements. Thus, we developed an algorithm to help select the optimal recipient vessels and appropriate anterolateral thigh perforator (ALTP) flap type. In addition, we performed surgery using this algorithm and achieved successful reconstructions. This study aims to review our experiences in algorithmic reconstruction and assess its efficacy. Methods According to the defect size and location, our algorithm suggested the use of various-shaped ALTP flaps with centrally located perforators (Cen-ALTP flap) or eccentrically located perforators (Ecc-ALTP flap). Besides, through the algorithm, one recipient vessel was selected among three candidates, including descending branch of the lateral circumflex femoral artery (DB-LCFA), anterior tibial artery (ATA), and posterior tibial artery (PTA). Based on this algorithmic decision, we performed individualized soft tissue reconstructions of the knee in 21 patients with CTKOM, between March 2013 and June 2021. The medical records of the patients were retrospectively reviewed. Results The Cen-ALTP flap (n = 15) and ATA (n = 9) were the most commonly used for reconstruction. The Cen-ALTP flap anastomosed to the ATA was most commonly selected (n = 7) using the algorithm, followed by the Cen-ALTP flap anastomosed to the DB-LCFA (n = 5), and the Cen-ALTP flap anastomosed to the PTA (n = 3). All transferred ALTP flaps survived the follow-up period. Postoperative venous congestion in two patients and hematoma in one patient were resolved by immediate treatment. The postoperative course was uneventful. Conclusion During free ALTP flap transfer to CTKOM-related knee defects, we could select the optimal recipient vessel and appropriate flap type using our algorithm and obtain excellent reconstructive outcomes. Therefore, we believe that our algorithm could provide helpful guidance to reconstructive surgeons on free ALTP flap transfer to reconstruct CTKOM-related soft tissue defects.
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Gonzalez J, Gardikiotis I, Ruiz-Moya A, Fontdevila J, Weshahy O, Palacin J, Vinals J, Hong JP. Duplex echography as an adjuvant tool to clinical examination to detect early postoperative free flap vascular compromise. Microsurgery 2020; 41:109-118. [PMID: 33373066 DOI: 10.1002/micr.30699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/09/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Clinical examination remains the cornerstone for postoperative monitoring of free flaps but is highly dependent on the surgeon's ability and experience. Duplex echography provides a noninvasive objective evaluation of tissue perfusion. The authors hypothesized that duplex echography may be a more sensitive and specific monitoring method for early detection of postoperative flap compromise compared to clinical examination alone. The goal was to evaluate any differences between combined duplex echography and clinical examination flap monitoring versus isolated clinical evaluation. METHODS A total of 730 free flaps in 700 patients were included in the study. We conducted an intra-subject prospective study of a cohort of patients who underwent free flap reconstruction in our unit to compare clinical examination with duplex echography for postoperative monitoring. An inter-subject study was also undertaken comparing the prospective cohort with a historical control group of patients in whom free flap monitoring was made using clinical examination alone. The patency flow and velocities through the artery and vein of the flap were measured at the donor and recipient vessels of every anastomosis by duplex scanning, by the same plastic surgeon every 4 hr, during the first 18 hr after surgery. RESULTS Duplex echography and clinical evaluation were used in 175 patients. The historical cohort included a total of 525 flaps. Every patient with suspicion of vascular compromise based on duplex echography was taken back for surgical re-exploration. There were no cases of overdiagnosis using duplex echography (Sensitivity 100%, Specificity 100%). Clinical evaluation detected issues with the vascularan astomoses in 23/175 flaps. However, it failed to detect 12/22 cases which presented with vascular complications and gave a false indication of possible complications in 13 flaps (Sensitivity 45%, Specificity 92%). CONCLUSION In our practice, duplex echography is considered a useful adjunct monitoring tool for early detection of postoperative flap compromise, which compliments clinical evaluation. It provides anatomic and hemodynamic information of the vascular status and may therefore increase survival of flaps by allowing earlier detection of vascular compromise, compared to clinical examination alone, in postoperative monitoring of free flaps.
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Affiliation(s)
- Jesus Gonzalez
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Clinic Barcelona Hospital University, Spain
| | - Ioannis Gardikiotis
- Department of Plastic Surgery, Grigore T. Popa University of Medicine and Pharmacy of Iasi, CEMEX, Sf. Maria Children's Emergency Hospital, Lasi, Romania
| | | | - Joan Fontdevila
- Department of Plastic Surgery, Clinic Barcelona Hospital University, Barcelona, Spain
| | - Omar Weshahy
- Department of Plastic Surgery, Clinic Barcelona Hospital University, Barcelona, Spain
| | - Jose Palacin
- Department of Plastic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Joan Vinals
- Department of Plastic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, Seoul, South Korea
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Kehrer A, Lonic D, Heidekrueger P, Bosselmann T, Taeger CD, Lamby P, Kehrer M, Jung EM, Prantl L, Platz Batista da Silva N. Feasibility study of preoperative microvessel evaluation and characterization in perforator flaps using various modes of color-coded duplex sonography (CCDS). Microsurgery 2020; 40:750-759. [PMID: 32931078 DOI: 10.1002/micr.30648] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 07/14/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Color-coded duplex sonography (CCDS) is useful for perforator flap design showing the highest sensitivity in identifying microvessels. This prospective study evaluates the feasibility of different ultrasound (US) modes applied by the microsurgeon in daily practice suggesting quantifiable reference values. METHODS Twenty-four patients aged between 17 and 68 years (mean 43.3 ± 14.2 years) with 18 anterolateral thigh (ALT) and 6 superficial circumflex iliac artery (SCIP) flaps were included. Indications were traumatic (n = 12), infectious (n = 6), ischemic (n = 4), or tumor-associated defects (n = 2). Different US modes were evaluated regarding applicability using multifrequency linear probes (5-15 MHz). Vessels diameter, peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were measured. Preoperative results were correlated to intraoperative findings. RESULTS In the examined patient group with 24 perforator flaps a 100% correlation was seen when comparing perforators detected with CCDS/PD with intraoperative findings using optimized US settings. Sensitivity, PPV, and accuracy of CCDS were 100% respectively. Mean PSV of 16.99 ± 6.07 cm/s, mean EDV of 5.01 ± 1.84 cm/s and RI of 0.7 ± 0.07 were measured in microvessels (PW-mode). CCDS proved to be superior compared to PD in correct diameter assessment showing a mean diameter of 1.65 ± 0.45 mm, compared to PD-mode 1.31 ± 0.24 mm. Mean PSV and EDV were higher in ALT than in SCIP flaps, RI was slightly higher in SCIP flaps (p > .05). There were no significant differences in size of different flaps' perforators (p > .05). CONCLUSION CCDS represents a highly valuable tool in the daily practice of free flap reconstructions using optimized low flow US settings and multifrequency linear probes.
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Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Daniel Lonic
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Paul Heidekrueger
- Bogenhausen Hospital, Academic Teaching Hospital of Technical University Munich, Department of Plastic, Reconstructive, Hand and Burn Surgery, Germany
| | - Talia Bosselmann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Philipp Lamby
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Germany
| | - Michael Kehrer
- Department of Trauma Surgery, University Hospital Bonn, Germany
| | | | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Germany
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González Martínez J, Torres Pérez A, Gijón Vega M, Nuñez-Villaveiran T. Preoperative Vascular Planning of Free Flaps: Comparative Study of Computed Tomographic Angiography, Color Doppler Ultrasonography, and Hand-Held Doppler. Plast Reconstr Surg 2020; 146:227-237. [PMID: 32740566 DOI: 10.1097/prs.0000000000006966] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Preoperative planning of microsurgical perforator free flaps continues to be a discussion topic among microsurgeons. The purpose of this study was to compare the ability of three methods of preoperative vascular mapping-hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography-to detect perforators and their concordance with surgical findings. METHODS A prospective study was performed to evaluate the sensitivity, specificity, and accuracy of hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography to detect free flap perforators. Each patient undergoing a free flap reconstruction was studied preoperatively with the three methods, and the results were compared to the intraoperative findings. RESULTS Fifty-three patients undergoing autologous tissue reconstruction were included. Most reconstructions (71.7 percent) were performed with anterolateral thigh flaps. The positive predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 100 percent; hand-held Doppler imaging, 88.6 percent) and negative predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 94.3 percent; hand-held Doppler imaging, 90.5 percent) rates were significantly different between methods. The high resolution of the color Doppler ultrasonography probe provided a direct vision of the vasculature arborization and efficiently detected vessels with diameters of less than 0.5 mm. The sensitivity, specificity, and accuracy of color Doppler ultrasonography were greater than those of both computed tomographic angiography and hand-held Doppler imaging. There was 100 percent concordance between color Doppler ultrasonography perforators and the surgical findings. CONCLUSIONS Color Doppler ultrasonography provides a reproducible, harmless, and accurate way to visualize vascular anatomy. It has a high correlation with the surgical findings, signifying advantages over hand-held Doppler and computed tomographic angiography in sensitivity, specificity, and accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
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Affiliation(s)
- Jesús González Martínez
- From the Department of Plastic and Reconstructive Surgery, Hospital Clinic Barcelona; and the Department of Plastic and Reconstructive Surgery, Complejo Hospitalario Universitario Albacete
| | - Asia Torres Pérez
- From the Department of Plastic and Reconstructive Surgery, Hospital Clinic Barcelona; and the Department of Plastic and Reconstructive Surgery, Complejo Hospitalario Universitario Albacete
| | - María Gijón Vega
- From the Department of Plastic and Reconstructive Surgery, Hospital Clinic Barcelona; and the Department of Plastic and Reconstructive Surgery, Complejo Hospitalario Universitario Albacete
| | - Teresa Nuñez-Villaveiran
- From the Department of Plastic and Reconstructive Surgery, Hospital Clinic Barcelona; and the Department of Plastic and Reconstructive Surgery, Complejo Hospitalario Universitario Albacete
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Kehrer A, Heidekrueger PI, Lonic D, Taeger CD, Klein S, Lamby P, Sachanadani NS, Jung EM, Prantl L, Batista da Silva NP. High-Resolution Ultrasound-Guided Perforator Mapping and Characterization by the Microsurgeon in Lower Limb Reconstruction. J Reconstr Microsurg 2020; 37:75-82. [PMID: 32110822 DOI: 10.1055/s-0040-1702162] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Preoperative ultrasound (US)-guided perforator mapping has immensely simplified perforator flap planning. It may be executed by the microsurgeon. Device settings and selection of ultrasound modes are of utmost significance for detection of low-flow microvessels. The following study evaluates different US modes. METHODS A prospective complete data acquisition was performed from July 2018 to June 2019 in a subset of patients who underwent US-guided flap planning. Multifrequency linear transducers were used applying five US modes. Brightness (B)-mode, color flow (CF), power Doppler (PD), pulse wave (PW), and B-flow modes were evaluated regarding applicability by microsurgeons. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were chosen to evaluate flow characteristics. US results were correlated to intraoperative findings. RESULTS A total number of eight patients (six males and two females) undergoing anterolateral thigh (ALT) or superficial circumflex iliac artery perforator (SCIP) flap surgery received an extensive standardized US-guided perforator characterization. Qualitative evaluation was performed in B-mode, color-coded duplex sonography (CCDS), PD, and B-flow mode. Quantitative assessment was executed using PW-mode and CCDS measuring the microvessels' diameter (mm) and flow characteristics (PSV, EDV, and RI). CCDS provided a mean diameter of 1.93 mm (range: 1.2-2.8 ± 0.51), a mean systolic peak of 16.9 cm/s (range: 9.9-33.4 ± 7.79), and mean RI of 0.71 (range: 0.55-0.87 ± 0.09) for lower limb perforators. All perforators located with US were verified by intraoperative findings. An optimized, time-effective US mapping algorithm was derived. Qualitative parameters may be evaluated with B-mode, CF, or B-flow. Smallest microvessels may be assessed in PD-mode. Lowering pulse-repetition frequency (PRF)/scale is mandatory to image low-flow microvessels as perforators. Quantitative information may be obtained using PW-mode and the distance-measuring tool in CF-mode. Image and video materials are provided. CONCLUSION CCDS proved to be a powerful tool for preoperative perforator characterization when using a structured approach and mapping algorithm. Different techniques may be applied for specific visualizations and performed by the microsurgeon.
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Affiliation(s)
- Andreas Kehrer
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Paul I Heidekrueger
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Daniel Lonic
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian D Taeger
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Silvan Klein
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Philipp Lamby
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Neil S Sachanadani
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Royal Oak, Detroit, Michigan
| | - Ernst Michael Jung
- Department of Radiology, Ultrasound Center, University Medical Center Regensburg, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
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Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - Basic and advanced applications and device settings. J Plast Reconstr Aesthet Surg 2019; 73:1081-1090. [PMID: 32249187 DOI: 10.1016/j.bjps.2019.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/02/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The anterolateral thigh (ALT) perforator flap is a popular reconstructive tissue transfer. Consistent with the "hot/cold zone" concept for rapid dissection and thin flap harvest, reliable preoperative perforator mapping is mandatory. Color-coded duplex sonography (CCDS) has been shown to have the highest pooled sensitivity and positive predictive value to identify ALT perforating vessels. By reviewing this guide, the reader should learn: 1. Probe selection and basic/advanced device settings 2. Interpreting tissue morphology 3. Structured mapping approach 4. Pedicle position planning 5. Safe flap design 6. Assess subcutaneous course and flap's thickness for subfascial/epifascial/suprafascial harvest 7. Implement perforators identified into a tailor-made flap design including chimeric flaps. METHODS Experiences with ultrasound-guided flap design gained from 125 ALT perforator flap free tissue transfers performed in two reconstructive centers was the basis of our guide. Our structured method comprises standardized markings, patient positioning, and simple ergonomics. Basic and advanced CCDS settings, selection, and conventional probe guidance are outlined for the microsurgeon. RESULTS Linear multifrequency probes (6-15 MHz) were used. Best preset programs were breast, thyroid, and vascular. Favorable device properties were depth focused to 2-5 cm, pulse repetition frequency (PRF/Scale) set low to 0.5-1.5 kHz/3-10 cm/s, color gain high, and wall filter (WF) low/off (< 50 Hz). Additional parameters were discussed. A 100% concordance rate was seen comparing preoperative perforator visualization with CCDS and intraoperative findings. Detailed picture and video material were demonstrated. CONCLUSION CCDS is a powerful tool for preoperative perforator mapping in perforator flaps such as the ALT.
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Simplified profunda artery perforator (PAP) flap design using power Doppler ultrasonography (PDU): A prospective study. Microsurgery 2017; 38:512-523. [DOI: 10.1002/micr.30266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/07/2017] [Accepted: 10/20/2017] [Indexed: 11/07/2022]
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Lethaus B, Loberg C, Kloss-Brandstätter A, Bartella AK, Steiner T, Modabber A, Hölzle F, Teichmann J. Color duplex ultrasonography versus handheld Doppler to plan anterior lateral thigh flaps. Microsurgery 2017; 37:388-393. [DOI: 10.1002/micr.30177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/02/2017] [Accepted: 03/10/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Bernd Lethaus
- Department of Cranio-Maxillofacial Surgery; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
| | - Christina Loberg
- Department of Diagnostic and Interventional Radiology; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
| | - Anita Kloss-Brandstätter
- Division of Genetic Epidemiology; Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University; Schöpfstraße 41 Innsbruck 6020 Austria
| | - Alexander K. Bartella
- Department of Cranio-Maxillofacial Surgery; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
| | - Timm Steiner
- Department of Cranio-Maxillofacial Surgery; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
| | - Ali Modabber
- Department of Cranio-Maxillofacial Surgery; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
| | - Frank Hölzle
- Department of Cranio-Maxillofacial Surgery; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
| | - Jan Teichmann
- Department of Cranio-Maxillofacial Surgery; RWTH Aachen University; Pauwelsstraße 30 Aachen 52074 Germany
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Gravvanis A, Kyriakopoulos A, Kateros K, Tsoutsos D. Flap reconstruction of the knee: A review of current concepts and a proposed algorithm. World J Orthop 2014; 5:603-613. [PMID: 25405089 PMCID: PMC4133468 DOI: 10.5312/wjo.v5.i5.603] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/20/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.
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Gravvanis A, Tsoutsos D, Papanikolaou G, Diab A, Lambropoulou P, Karakitsos D. Refining perforator selection for deep inferior epigastric perforator flap: The impact of the dominant venous perforator. Microsurgery 2013; 34:169-76. [DOI: 10.1002/micr.22193] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/26/2013] [Accepted: 09/05/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Andreas Gravvanis
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527; Athens Greece
| | - Dimosthenis Tsoutsos
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527; Athens Greece
| | - George Papanikolaou
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527; Athens Greece
| | - Ahmed Diab
- Department of Plastic Surgery, Microsurgery and Burn Center “J. Ioannovich,” General State Hospital of Athens “G. Gennimatas,” 11527; Athens Greece
| | - Penelope Lambropoulou
- Department of Radiology, General State Hospital of Athens “G. Gennimatas,” 11527; Athens Greece
| | - Dimitrios Karakitsos
- Intensive Care Unit, General State Hospital of Athens “G. Gennimatas,” 11527; Athens Greece
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