Cent cinquante-sept lambeaux pédiculés utilisés dans la reconstruction des membres inférieurs : étude rétrospective sur dix ans

Extensor digitorum brevis muscle flap for lower extremity coverage in a context of posttraumatic sepsis

INTRODUCTION

Traumatic injuries to the distal quarter of the leg present a significant risk of skin necrosis and exposure of the underlying fracture site or the osteosynthesis material that often result in bone and joint infection. In the case of small or medium-sized bone exposure, local muscles may be one of the best options for lower extremity coverage. We describe our experience using the extensor digitorum brevis muscle flap in a context of posttraumatic bone and joint infection in fourteen patients. Our main objective was to assess the outcomes and the donor-site morbidity of the extensor digitorum brevis muscle flap.

MATERIALS AND METHODS

A single-center retrospective study in a French reference center for bone and joint infection from 2014 to 2018 reviewed cases of traumatic injuries with skin complications and bone and joint infection that required an extensor digitorum brevis muscle flap coverage. Fourteen patients were evaluated for early and late complications, 11 men and three women with a mean age of 51.4±17.72 (19-71) years. Seven of these were open fractures and nine cases were pilon fractures. Donor-site morbidity was assessed in nine patients.

RESULTS

Early flap complications included two cases (14.2%) of hematoma, one case (7.1%) of partial necrosis and four cases (28.5%) of donor-site dehiscence. Late complications caused by persistent infection were found in two patients (14.2%), with one case (7.1%) of chronic osteoarthritis and one case (7.1%) of septic pseudarthrosis. From a functional and cosmetic point of view, eight patients (89%) were satisfied, to very satisfied.

CONCLUSION

Experience and a multidisciplinary approach are keys in providing an optimal treatment strategy for complex cases of bone and joint infection. The extensor digitorum brevis muscle is a reliable flap for small defects with underlying infection. Being made up of muscle tissue, this flap offers good resistance to infection and enables satisfactory distribution of antibiotics.

LEVEL OF EVIDENCE

IV.

Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

[New cutaneous strategy in sural flap surgery and possibility to adapt this technique to other pedicled flaps]

INTRODUCTION

Therapeutic managements in losses of substance of the lower limb using sural flap give an important scar and, sometimes, an impossibility to close the flap donor site. That led us to think about an operative procedure that can reduce those scars without increasing the risk of necrosis of the cutaneous paddle.

PATIENTS AND METHOD

We present this operative procedure which underwent in the plastic and reconstructive surgery service in our hospital. Classical flap procedure with two cutaneous parts was used. The cutaneous laxity was evaluated so as to close with one cutaneous part; the other cutaneous part was taken and used like a skin graft after the suture of the calf and the formation of a bursa on the donor site. The leg was closed with only one cutaneous flap.

RESULTS

This technique is illustrated by a case report. Results at the 4th month are very interesting with an acceptable scar and a good result of the skin graft. However, with this technique, we don't decrease the venous risk of this flap. We used this technique for an antebrachial flap.

CONCLUSION

This technique is an easy and reliable technique based on cutaneous laxity and that decreases scarring of this very useful flap: the neurocutaneous sural flap. We can have a diminution of the number of surgery, a diminution of the scar and good aesthetics results.