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Chang S, Jian Y, Liu C, Dal Prà I, Armato U, Chen X, Zhou J, Chen W, Zhang F, Nie K, De Santis D, Deng C, Wei Z. Combining antibiotic-loaded bone cement-based free vastus lateralis muscle-sparing flap with split-thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non-weight-bearing areas. Int Wound J 2024; 21:e14900. [PMID: 38705731 PMCID: PMC11070315 DOI: 10.1111/iwj.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/07/2024] Open
Abstract
Diabetic foot ulcers (DFUs) present significant challenges due to their associated amputation rates, mortality, treatment complexity and excessive costs. Our earlier work introduced a wound surgical integrated treatment (WSIT) for DFUs, yielding promising outcomes. This study focuses on a specific WSIT protocol employing antibiotic-loaded bone cement (ALBC) in the first Stage, and free vastus lateralis muscle-sparing (VLMS) flaps and split-thickness skin grafts (STSGs) in the second stage to repair non-weight-bearing DFUs. From July 2021 to July 2023, seven DFU patients (aged 47-71 years) underwent this treatment. Demographic data, hospital stay and repair surgery times were collected. Histological and immunohistochemical analyses assessed angiogenesis, collagen deposition and inflammation. SF-36 questionnaire measured pre- and postoperative quality of life. Preoperative ultrasound Doppler showed that the peak blood flow velocity of the recipient area artery was significantly >30 cm/s (38.6 ± 6.8 cm/s) in all patients. Muscle flap sizes varied from 8 × 3.5 × 1 to 18 × 6 × 2 cm. The operation time of the repair surgery was 156.9 ± 15.08 minutes, and the hospital stay was 18.9 ± 3.3 days. Histological analysis proved that covering DFUs with ALBC induced membrane formation and increased collagen, neovascularization and M2 macrophages fraction while reducing M1 macrophages one. All grafts survived without amputation during a 7- to 24-month follow-up, during which SF-36 scores significantly improved. A combination of ALBC with free VLMS flaps and STSGs proved to be safe and effective for reconstructing non-weight-bearing DFUs. It rapidly controlled infection, enhanced life quality and foot function, and reduced hospitalization time. We advocate integrating this strategy into DFU treatment plans.
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Affiliation(s)
- Shusen Chang
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Yang Jian
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Chenxiaoxiao Liu
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Ilaria Dal Prà
- Department of Surgery, Dentistry, Pediatrics & GynecologyUniversity of Verona Medical SchoolVeronaItaly
| | - Ubaldo Armato
- Department of Surgery, Dentistry, Pediatrics & GynecologyUniversity of Verona Medical SchoolVeronaItaly
| | - Xin Chen
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Jian Zhou
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Wei Chen
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Fang Zhang
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Kaiyu Nie
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Daniele De Santis
- Department of Surgery, Dentistry, Pediatrics & GynecologyUniversity of Verona Medical SchoolVeronaItaly
| | - Chengliang Deng
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
| | - Zairong Wei
- Department of Burns and Plastic SurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiPR China
- The Collaborative Innovation Center, Tissue Damage Repair and Regeneration Medicine of Zunyi Medical UniversityZunyiPR China
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List EB, Boers N, Martin E, Krijgh DD, Henk Coert J. Patient-reported outcomes after free muscle flap coverage for therapy-resistant neuropathic pain from the ulnar nerve. J Hand Surg Eur Vol 2024; 49:250-256. [PMID: 37747704 PMCID: PMC10845818 DOI: 10.1177/17531934231201930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023]
Abstract
Extensive microsurgical neurolysis followed by free gracilis muscle flap coverage can be performed as a last resort for patients with persistent neuropathic pain of the ulnar nerve. All patients who had this surgery between 2015 and 2021 were identified. Data were collected from the medical records of 21 patients and patient-reported outcomes were collected from 18 patients, with a minimum follow-up of 12 months. The median visual analogue pain score decreased significantly 8 months postoperatively from 8.0 to 6.0 and stabilized to 5.4 at the 3-year follow-up. Health-related quality-of-life scores remained diminished compared to normative data. In the treatment of therapy-resistant neuropathic pain of the ulnar nerve, extensive neurolysis with a subsequent free gracilis muscle flap coverage shows a promising reduction of pain that persists at long-term follow-up.Level of evidence: IV.
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Affiliation(s)
- Emile B. List
- Emile B. List, Department of Plastic and Reconstructive Surgery G04.126, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | | | - Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David D. Krijgh
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J. Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Scharfetter S, Schwaiger K, Wechselberger G. The Subcalcaneal Fat Pad: An Innovative Space for Passage of the Pedicle in Free Flap Reconstruction of Lateral Heel Defects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5412. [PMID: 38025646 PMCID: PMC10656083 DOI: 10.1097/gox.0000000000005412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023]
Abstract
Soft-tissue defects of the lateral heel remain a challenge for reconstructive surgeons. Although a reliable vascular supply for free flap anastomosis is available anteriorly from the anterior tibial vessels and medially from the posterior tibial vessels, the vascular anatomy of the lateral side lacks suitable donor vessels for free flap anastomoses. Although the pedicle can be passed either ventrally beneath the skin or dorsally between the Achilles tendon and calcaneus, these passages are hardly applicable for lateral heel defects. We identified the space between the plantar surface of the calcaneus and the plantar aponeurosis as an innovative approach for reconstruction. Therefore, we propose the subcalcaneal fat pad as an alternative and reliable route for the passage of the flap pedicle to the posterior tibial vessels in free flap reconstruction of soft-tissue defects in the lateral calcaneal region. Consequently, the vascular pedicle can be safely anastomosed to the posterior tibial vessels. This approach provides a new option for recipient vessels in free flap reconstruction.
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Affiliation(s)
- Sandra Scharfetter
- From the Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of the Brothers of St. John of Gods, Paracelsus Medical University, Salzburg, Austria
| | - Karl Schwaiger
- From the Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of the Brothers of St. John of Gods, Paracelsus Medical University, Salzburg, Austria
| | - Gottfried Wechselberger
- From the Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of the Brothers of St. John of Gods, Paracelsus Medical University, Salzburg, Austria
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Fricke A, Rassner M, Kiefer J, Eisenhardt SU. The esthetic outcome of recipient sites of gracilis muscle flaps versus anterolateral thigh flaps: A retrospective study. Microsurgery 2023; 43:800-808. [PMID: 36922726 DOI: 10.1002/micr.31035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Anterolateral thigh (ALT) and gracilis muscle flaps have been described as comparable reconstructive options regarding maximal flap dimension and indications. However, split-thickness skin-grafted muscle flaps are generally believed to be inferior to perforator flaps regarding the esthetic outcome of the recipient site. The purpose of this study was to challenge this assumption, comparing the long-term esthetic outcome of the gracilis and the ALT flap. METHODS One hundred forty-eight patients who had undergone free flap reconstruction with either free split-thickness skin-grafted gracilis muscle flaps (n = 86) or ALT flaps (n = 62) were evaluated in the study. Patients' satisfaction with the esthetic outcome, rates of flap loss, wound healing disorders and the necessity for thinning the flap or scar correction procedures were assessed. RESULTS Flap loss occurred in 4 of 86 gracilis flaps (4.7%) and 2 of 62 (3.2%) ALT flaps (p > .9999). Thinning or scar correction procedures were necessary for 6 of 86 gracilis (7.0%) and 4 of 62 (6.5%; p > .9999) ALT flap recipient sites. Regarding the overall patients' satisfaction with the esthetic outcome, scores were similar in both groups (2.667 [ALT] vs. 2.348 [gracilis]; p = .3739). Contour deformity, scar hypertrophy, and difference in flap color/texture in relation to the surrounding skin were comparable throughout the ALT and gracilis group (2.667 vs. 2.174, p = .2099; 3.333 vs. 2.739, p = .0912 and 2.500 vs. 2.174, p = .3159, respectively). CONCLUSION The gracilis and ALT flap are two equivalent reconstructive options regarding the esthetic outcome of the recipient site and long-term patient satisfaction.
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Affiliation(s)
- A Fricke
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - M Rassner
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - J Kiefer
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
| | - S U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Faculty of the University of Freiburg, University of Freiburg Medical Centre, Freiburg, Germany
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Tan CH, Wu Y, Satkunanantham M. Flaps for lower limb diabetic wound reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 79:74-86. [PMID: 36870103 DOI: 10.1016/j.bjps.2023.01.032] [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: 08/26/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The treatment of chronic diabetic wounds includes wound dressing, debridement, flap surgery, and amputation. For suitable patients with nonhealing wounds, locoregional flaps or free flaps may be used. This paper aims to review the outcomes of flap surgery and identify the risk factors for flap loss. METHODS MEDLINE, Embase, and Cochrane Library were searched. Articles reporting flap loss outcomes for flap surgery in lower limb chronic diabetic wounds were included. Case reports and case series with fewer than five patients were excluded. A subset of articles was used for revascularization subgroup analysis and another subset for meta-analysis of risk factors for flap loss. RESULTS In the free flap group, the total flap failure rate was 7.14% and partial flap failure rate was 7.54%. The rate of major complications requiring operative takeback was 19.0%. Early mortality was 2.76%. In the locoregional flap group, the total flap failure rate was 3.24% and partial flap failure rate was 5.36%. The rate of major complications requiring operative takeback was 13.3%. There was no early mortality. The rate of free flap loss was 18.2% with revascularization, significantly higher than 6.66% without revascularization. CONCLUSIONS Our findings concur with previously published studies on flap loss and complications in diabetic lower limb wounds. There is an increased risk of flap loss in patients who require free flap and revascularization compared to patients who only require free flap. This could be because of the fragile and fibrotic vessels found in diabetics with comorbid atherosclerosis.
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Affiliation(s)
| | | | - Mala Satkunanantham
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore
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The Gracilis Muscle Flap: A “Work Horse” Free Flap in Diabetic Foot Reconstruction. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.2.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Melissinos EG, Maiorino EJ, Marques ES. Use of the Adductor Magnus Muscle Free Flap for Lower-Extremity Soft Tissue Coverage: An Alternative to the Gracilis Muscle Flap With Unfavorable Vascular Anatomy. Ann Plast Surg 2021; 86:46-51. [PMID: 32541539 DOI: 10.1097/sap.0000000000002433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The gracilis muscle free flap has proven to be a dependable tool for the reconstructive microsurgeon for coverage of small- to medium-sized lower-extremity soft tissue defects because of its reliable anatomy, ease of elevation, and minimal donor site morbidity. We describe our experience with the adductor magnus muscle free flap which we have utilized in cases when confronted with the rare situation in which the dominant vascular pedicle to the gracilis muscle is insufficient or absent. METHODS We conducted a retrospective chart review of a single surgeon's experience (EG Melissinos) over an 18-year period of all patients that underwent adductor magnus muscle free flap coverage for lower-extremity soft tissue injuries. RESULTS Twenty-four adductor magnus free flaps in 24 patients were performed over an 18-year period (2000-2018). All of the adductor magnus muscle free flaps were performed with the initial intention of gracilis muscle harvest for lower-extremity soft tissue coverage. The most common wound etiology was motor vehicle collisions (8 patients, 33%). All of the adductor magnus free flaps were used for coverage of lower-extremity wounds in the following anatomic locations: distal third (10 patients, 41.7%), ankle (11 patients, 45.8%) and foot (3 patients, 12.5%). All flaps were successful. There were minimal donor site complications. Limb salvage rate was 100%. CONCLUSIONS Use of the adductor magnus muscle free flap is a reasonable alternative to the gracilis muscle in cases when unfavorable gracilis vascular anatomy is encountered intraoperatively. It can be easily and safely harvested within the same donor incision and permits reliable coverage of small- to medium-sized lower-extremity soft tissue defects while avoiding the morbidity of a secondary donor site.
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Affiliation(s)
- Emmanuel G Melissinos
- From the Division of Plastic Surgery, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston; and Memorial Hermann Hospital-Texas Medical Center, Houston, TX
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Heidekrueger PI, Ehrl D, Ninkovic M, Thiha A, Prantl L, Herter F, Mueller C, Broer PN. The spreaded gracilis flap revisited: Comparing outcomes in lower limb reconstruction. Microsurgery 2017; 37:873-880. [DOI: 10.1002/micr.30245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Paul Immanuel Heidekrueger
- Department for Plastic, Reconstructive, Hand, and Burn SurgeryStKM‐Klinikum Bogenhausen, Academic Teaching Hospital, Technical University MunichMunich Germany
- Center of Plastic, Hand and Reconstructive SurgeryUniversity Medical Center RegensburgRegensburg Germany
| | - Denis Ehrl
- Department for Plastic, Reconstructive, Hand, and Burn SurgeryStKM‐Klinikum Bogenhausen, Academic Teaching Hospital, Technical University MunichMunich Germany
| | - Milomir Ninkovic
- Department for Plastic, Reconstructive, Hand, and Burn SurgeryStKM‐Klinikum Bogenhausen, Academic Teaching Hospital, Technical University MunichMunich Germany
| | - Aung Thiha
- Center of Plastic, Hand and Reconstructive SurgeryUniversity Medical Center RegensburgRegensburg Germany
| | - Lukas Prantl
- Center of Plastic, Hand and Reconstructive SurgeryUniversity Medical Center RegensburgRegensburg Germany
| | - Frank Herter
- Department for Plastic, Reconstructive, Hand, and Burn SurgeryStKM‐Klinikum Bogenhausen, Academic Teaching Hospital, Technical University MunichMunich Germany
| | - Camillo Mueller
- Department for Plastic and Hand SurgeryCHUV Centre de la MainLausanne Switzerland
| | - Peter Niclas Broer
- Department for Plastic, Reconstructive, Hand, and Burn SurgeryStKM‐Klinikum Bogenhausen, Academic Teaching Hospital, Technical University MunichMunich Germany
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Franco MJ, Nicoson MC, Parikh RP, Tung TH. Lower Extremity Reconstruction with Free Gracilis Flaps. J Reconstr Microsurg 2016; 33:218-224. [PMID: 28024305 DOI: 10.1055/s-0036-1597568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background There have been significant advancements in lower extremity reconstruction over the last several decades, and the plastic surgeon's armamentarium has grown to include free muscle and fasciocutaneous flaps along with local perforator and propeller flaps. While we have found a use for a variety of techniques for lower extremity reconstruction, the free gracilis has been our workhorse flap due to the ease of harvest, reliability, and low donor site morbidity. Methods This is a retrospective review of a single surgeon's series of free gracilis flaps utilized for lower extremity reconstruction. Demographic information, comorbidities, outcomes, and secondary procedures were analyzed. Results We identified 24 free gracilis flaps. The duration from injury to free flap coverage was ≤ 7 days in 6 patients, 8-30 days in 11 patients, 31-90 days in 4 patients, and > 90 days in 3 patients. There were 22 (92%) successful flaps and an overall limb salvage rate of 92%. There was one partial flap loss. Two flaps underwent incision and drainage in the operating room for infection. Two patients developed donor site hematomas. Four patients underwent secondary procedures for contouring. Our subset of pediatric patients had 100% flap survival and no secondary procedures at a mean 30-month follow-up. Conclusion This study demonstrates the utility of the free gracilis flap in reconstruction of small- to medium-sized defects of the lower extremity. This flap has a high success rate and a low donor site morbidity. Atrophy of the denervated muscle over time allows for good shoe fit, often obviating the need for secondary contouring procedures.
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Affiliation(s)
- Michael J Franco
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael C Nicoson
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rajiv P Parikh
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas H Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
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Xiong L, Gazyakan E, Kremer T, Hernekamp FJ, Harhaus L, Saint-Cyr M, Kneser U, Hirche C. Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety. Microsurgery 2016; 36:511-24. [DOI: 10.1002/micr.30020] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/31/2015] [Accepted: 12/08/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Lingyun Xiong
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
- Department of Plastic and Reconstructive Surgery; Aesthetic Surgery Center, Union Hospital, Huazhong University of Science and Technology; 430022 Wuhan P.R. China
| | - Emre Gazyakan
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
| | - Thomas Kremer
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
| | - Frederick J. Hernekamp
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Department of Surgery; Mayo Clinic; Rochester MN 55905
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
| | - Christoph Hirche
- Department of Hand-, Plastic and Reconstructive Surgery; Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg; Ludwigshafen 67071 Germany
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Besset M, Penaud A, Quignon R, Bahe L, Brilhault J, Fouquet B. Évaluation des séquelles du site donneur du lambeau libre de muscle gracilis. À propos de 32 cas. ANN CHIR PLAST ESTH 2014; 59:53-60. [DOI: 10.1016/j.anplas.2013.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/11/2013] [Indexed: 11/16/2022]
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Le lambeau libre de muscle gracilis en chirurgie reconstructrice du pied, de la cheville et du tiers distal de la jambe. ANN CHIR PLAST ESTH 2014; 59:42-52. [DOI: 10.1016/j.anplas.2013.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022]
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Abbas AH, Ghobashy WA, Moghazy AM. Binocular single-refraction magnifying glasses for free flap surgery: a reliable method for developing countries. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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McCartan B, Dinh T. The use of split-thickness skin grafts on diabetic foot ulcerations: a literature review. PLASTIC SURGERY INTERNATIONAL 2012; 2012:715273. [PMID: 22666573 PMCID: PMC3361270 DOI: 10.1155/2012/715273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 12/05/2011] [Accepted: 01/04/2012] [Indexed: 02/07/2023]
Abstract
Diabetic foot ulcerations are historically difficult to treat despite advanced therapeutic modalities. There are numerous modalities described in the literature ranging from noninvasive topical wound care to more invasive surgical procedures such as primary closure, skin flaps, and skin grafting. While skin grafting provides faster time to closure with a single treatment compared to traditional topical wound treatments, the potential risks of donor site morbidity and poor wound healing unique to the diabetic state have been cited as a contraindication to its widespread use. In order to garner clarity on this issue, a literature review was undertaken on the use of split-thickness skin grafts on diabetic foot ulcers. Search of electronic databases yielded four studies that reported split-thickness skin grafts as definitive means of closure. In addition, several other studies employed split-thickness skin grafts as an adjunct to a treatment that was only partially successful or used to fill in the donor site of another plastic surgery technique. When used as the primary closure on optimized diabetic foot ulcerations, split-thickness skin grafts are 78% successful at closing 90% of the wound by eight weeks.
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Affiliation(s)
- Brant McCartan
- Division of Podiatry, Beth Israel Deaconess Medical Center, 185 Pilgrim Road Baker 3, Boston, MA 02215, USA
| | - Thanh Dinh
- Division of Podiatry, Beth Israel Deaconess Medical Center, 185 Pilgrim Road Baker 3, Boston, MA 02215, USA
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Supermicrosurgery in Peroneal and Soleus Perforator-Based Free Flap Coverage of Foot Defects Caused by Occlusive Vascular Diseases. Plast Reconstr Surg 2010; 126:499-507. [DOI: 10.1097/prs.0b013e3181df64c2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125:924-34. [PMID: 20009789 DOI: 10.1097/prs.0b013e3181cc9630] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Free tissue transfer to the lower extremity has become a well-established reconstructive modality. The purpose of this study was to develop a "subunit" approach to patients undergoing free tissue transfer for foot and ankle wounds to help further define subunit-specific functional and aesthetic operative goals. METHODS The institutional review board approved this retrospective review of 161 patients who underwent free tissue transplantation for foot and ankle wounds between March 1, 1997, and February 28, 2007, at a single institution. Endpoints included flap-related complications, secondary surgery, time to ambulation, flap stability, and limb salvage. RESULTS The most common types of wounds treated were trauma-related [n = 120 (75 percent)], diabetes-related [n = 24 (15 percent)], and oncologic defects [n = 8 (5 percent)]. Ten different donor sites were used for reconstruction, with the latissimus dorsi flap being the most common. The mean follow-up time was 26.9 months (range, 0.5 to 130 months). Mean time to ambulation was 3.1 months (range, 0.75 to 14 months). Overall, 11 percent of patients required revision surgery for flap instability at a mean time of 25.3 months after flap surgery. Wounds located over the heel (subunit 5) were most likely to develop instability (Fisher's exact test, p < 0.05). The overall 5-year limb salvage rate as determined by Kaplan-Meier analysis was 89 percent. CONCLUSIONS The use of free tissue transplantation for treatment of foot and ankle wounds is associated with a high rate of limb salvage. Although a variety of flaps may be used, the application of the subunit principle can assist surgeons in designing flaps that will address subunit-specific functional and aesthetic concerns.
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Influencing Factors of Outcome After Lower-Limb Amputation: A Five-Year Review in a Plastic Surgical Department. Ann Plast Surg 2008; 61:314-8. [DOI: 10.1097/sap.0b013e3181571379] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Complex Perineal and Groin Wound Reconstruction Using the Extended Dissection Technique of the Gracilis Flap. Plast Reconstr Surg 2008; 122:472-478. [DOI: 10.1097/prs.0b013e31817d607d] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. They defy cure using conventional and simple "dressings" therapy and currently have a major socioeconomic impact. The purpose of this review is to bring these wounds to the attention of the health-care community, suggesting that they should be treated by multidisciplinary teams in specialized hospital centers. In most cases, surgical treatment is unavoidable, because the extent of skin and subcutaneous tissue loss requires reconstruction with grafts and flaps. New technologies, such as the negative pressure device, should be introduced. A brief review is provided of the major groups of complex wounds--diabetic wounds, pressure sores, chronic venous ulcers, post-infection soft-tissue gangrenes, and ulcers resulting from vasculitis.
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Affiliation(s)
- Marcus Castro Ferreira
- Division of Plastic Surgery, Hospital das Clínicas, São Paulo University Medical School, São Paulo, SP, Brazil.
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