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Martić K, Vojvodić B, Gorjanc B, Budimir I, Tucaković H, Caktaš D, Žic R, Jaman J. Feet Salvage Using Anterolateral Thigh Flaps after Severe Frostbite Injury: A Case Report. J Pers Med 2024; 14:389. [PMID: 38673016 PMCID: PMC11051273 DOI: 10.3390/jpm14040389] [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: 02/04/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Frostbite is a severe injury characterized by tissue damage due to exposure to freezing temperatures. It often necessitates prompt medical intervention to prevent further complications such as necrosis and amputation. This case report explores the successful use of bilateral anterolateral thigh (ALT) free flaps for feet salvage in a 19-year-old male refugee from Gambia who suffered severe frostbite injuries. CASE REPORT The patient, found after six days in freezing conditions, exhibited necrosis on multiple toes. Initial management included stabilization, intravenous fluids, and rewarming. Subsequent necrectomy and amputation revealed exposed metatarsal bones, necessitating a meticulous reconstructive strategy. Bilateral ALT flaps were chosen to preserve walking function, with a staged reconstruction involving multiple operations. The patient's progress, from inpatient care to outpatient follow-ups, is detailed, emphasizing the challenges and decisions in managing severe frostbite injuries. RESULTS The surgical intervention utilizing bilateral ALT flaps successfully salvaged the patient's feet. Throughout the postoperative period, wound care, rehabilitation, and outpatient monitoring contributed to positive outcomes. Despite challenges associated with the patient's ethnic background and nutritional status, the staged reconstruction facilitated effective healing and functional recovery. The use of ALT flaps provided a reliable solution with minimal donor site morbidity. CONCLUSION This case highlights the efficacy of bilateral ALT flap reconstruction in salvaging feet following severe frostbite injury. The successful restoration of foot function underscores the importance of early intervention and tailored reconstructive approaches in frostbite management. Despite patient-specific challenges, including nutritional status and limited healthcare resources, the use of ALT flaps facilitated optimal recovery and functional outcomes. Importantly, this report is unique as it describes a novel case of feet salvage using bilateral ALT flaps in severe frostbite injury, with only one similar case previously reported in the literature. This emphasizes the rarity and significance of this specific surgical approach in frostbite management.
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Affiliation(s)
- Krešimir Martić
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
- Department of Surgery, School of Medicine, University of Zagreb, Šalata 2, 10000 Zagreb, Croatia
| | - Borna Vojvodić
- Clinic for Traumatology, Sestre Milosrdnice University Hospital Center, Draškovićeva 19, 10000 Zagreb, Croatia
| | - Božo Gorjanc
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Ivan Budimir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Hrvoje Tucaković
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Doroteja Caktaš
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
| | - Rado Žic
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
- Department of Surgery, School of Medicine, University of Zagreb, Šalata 2, 10000 Zagreb, Croatia
| | - Josip Jaman
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia; (K.M.); (B.G.); (I.B.); (H.T.); (D.C.); (R.Ž.); (J.J.)
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Bae YC, Kim JH, Yi CC. The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot. Ann Plast Surg 2024; 92:424-431. [PMID: 38319983 DOI: 10.1097/sap.0000000000003745] [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: 02/08/2024]
Abstract
BACKGROUND Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole. METHODS This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021. RESULTS In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm 2 . Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively. CONCLUSIONS The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.
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Mert S, Heidekrueger PI, Fuchs B, Nuernberger T, Haas-Lützenberger EM, Giunta RE, Ehrl D, Demmer W. Microvascular Muscle vs. Fascio-Cutaneous Free Flaps for Reconstruction of Plantar Load-Bearing Foot Defects-An International Survey. J Clin Med 2024; 13:1287. [PMID: 38592127 PMCID: PMC10932295 DOI: 10.3390/jcm13051287] [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: 01/20/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy.
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Affiliation(s)
- Sinan Mert
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany (W.D.)
| | - Paul I. Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany
| | - Benedikt Fuchs
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany (W.D.)
| | - Tim Nuernberger
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany (W.D.)
| | | | - Riccardo E. Giunta
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany (W.D.)
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany (W.D.)
- Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Wolfram Demmer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, LMU Munich, 80336 Munich, Germany (W.D.)
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Zhang Z, Long J, Geng J, Xia W. Efficacy of autologous platelet-rich plasma for long-term glucocorticoids caused chronic wound: a case report. Cell Tissue Bank 2023; 24:705-710. [PMID: 36894793 DOI: 10.1007/s10561-023-10083-3] [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: 11/22/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
The repair of bone explore wounds is one of the difficult problems in plastic and reconstruction surgery. Platelet-rich plasma (PRP) is a safe and efficient therapeutic option for various trauma, including Osteoarticular, musculoskeletal, and Wound injuries. However, the preparation and storage of PRP becomes challenging for patients with poor systemic status and requiring multi-use of PRP. The availability of safe, reliable tissue bank makes it possible. We report a case of a 42-year-old woman patient with a chronic hip wound combined with ischium bone exploration. And the patient who was treated with long-term glucocorticoids for rheumatoid arthritis has been through the experience of extensive conservative management. Thereafter necrosectomy and Vacuum-Assisted Closure (VAC) surgical procedure failed, and a PRP daily injection was performed at the ischial muscle and soft tissue. Neo-muscle appeared around the explored ischium bone after 8 weeks of injection and Complete wound healing was obtained in 3 months.
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Affiliation(s)
- Ziang Zhang
- Department of Plastic Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Jie Long
- Department of Plastic Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Jian Geng
- Department of Plastic Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
| | - Wensen Xia
- Department of Plastic Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
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Morii H, Inui T, Shibayama H, Oae K, Onishi F, Hashimoto T, Inokuchi K, Sawano M. Arterialization of plantar venous system via vein graft: A novel technique for reconstruction of heel pad degloving injuries. Injury 2023; 54:110826. [PMID: 37286444 DOI: 10.1016/j.injury.2023.05.057] [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: 12/27/2022] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with heel pad degloving injury frequently develop ischemic necrosis of the area, necessitating soft-tissue reconstruction surgery. We have developed a technique for arterialization of the plantar venous system via vein graft (APV) as the primary revascularization treatment. The objective of this study was to clarify both the utility of APV for the preservation of degloved heel pads and the impact of this preservation on clinical outcomes. METHODS Ten consecutive cases of degloving injury with devascularized heel pad were treated at a single trauma center from 2008 to 2018. Five cases underwent APV and five underwent conventional primary suture (PS) as the initial treatment. We evaluated the course according to the frequency of heel pad preservation, additional intervention after heel pad necrosis, post-operative complications, and outcomes using the Foot and Ankle Disability Index score (FADI) at the time of last follow-up. RESULTS Among the five cases that underwent APV, the heel pad was preserved in three cases and flap surgery was required in two cases. All cases that underwent PS developed necrosis of the heel pad, requiring skin graft in one case and flap surgery in four. One skin graft case and one free flap case after PS developed plantar ulcers. The three cases with preserved heel pads exhibited higher FADI than the seven cases that developed necrosis. CONCLUSION APV showed a relatively high frequency of heel pad preservation, which otherwise was uniformly lacking. Functional outcomes were improved in cases with preserved heel pad compared to those that developed necrosis and underwent additional tissue reconstruction.
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Affiliation(s)
- Hokuto Morii
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Shibayama
- Department of Orthopaedic Surgery, KKR Sapporo Medical Center, Hokkaido, Japan
| | - Kazunori Oae
- Department of Orthopaedic Surgery, Hiroshima University School of Medicine, Hiroshima, Japan
| | - Fumio Onishi
- Department of Plastic Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Takuya Hashimoto
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Koichi Inokuchi
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Makoto Sawano
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Lansford JL, McCarthy CF, Souza JM, Saberski ER, Potter BK. Preventing biological waste: Effective use of viable tissue in traumatized lower extremities. OTA Int 2023; 6:e242. [PMID: 37448566 PMCID: PMC10337847 DOI: 10.1097/oi9.0000000000000242] [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: 11/17/2022] [Accepted: 12/17/2022] [Indexed: 07/15/2023]
Abstract
Severe open lower extremity trauma requires debridement to remove contamination and devitalized tissues. Aggressive debridement should be balanced with preservation of viable tissue. These often damaged but preserved viable tissues are "spare parts" that augment the options available for reconstruction. The long-term goal of reconstruction should be functional limb restoration and optimization. Injury patterns, levels, and patient factors will determine whether this endeavor is better accomplished with limb salvage or amputation. This article reviews the rationale and strategies for preserving spare parts throughout debridement and then incorporating them as opportunistic grafts in the ultimate reconstruction to facilitate healing and maximize extremity function. Level of Evidence 5.
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Affiliation(s)
| | | | - Jason M. Souza
- Ohio State University College of Medicine, Columbus, OH; and
| | - Ean R. Saberski
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of Health Sciences, Bethesda, MD
| | - Benjamin K. Potter
- Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of Health Sciences, Bethesda, MD
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Koulaxouzidis G, Schlagnitweit P, Anderl C, Braig D, Märdian S. Microsurgical Reconstruction in Orthopedic Tumor Resections as Part of a Multidisciplinary Surgical Approach for Sarcomas of the Extremities. Life (Basel) 2022; 12:1801. [PMID: 36362956 PMCID: PMC9695779 DOI: 10.3390/life12111801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2023] Open
Abstract
A central element of modern sarcoma therapy is complete surgical tumor resection with an adequate safety margin, embedded in an interdisciplinary multimodal therapy concept. Along with ensuring patient survival, functional limb preservation is an important goal for sarcomas of the extremities. This review provides an overview of the relevant literature on indications and goals of reconstructive options, the scope and contribution of microsurgical reconstructive procedures, and the associated interdisciplinary decision making and workup. Furthermore, the impact of (neo)-adjuvant therapy on reconstructive decisions will be highlighted. These aspects will be illustrated by four comprehensive case studies that demonstrate both useful strategies and the need for individually tailored therapies. Nowadays, extremity-preserving therapy is possible in more than 90% of sarcomas. Technical and procedural innovations such as microsurgery and microsurgical reconstructive procedures have significantly contributed to this evolution of therapy.
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Affiliation(s)
- Georgios Koulaxouzidis
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - Paul Schlagnitweit
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - Conrad Anderl
- Department of Orthopaedic Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - David Braig
- Department of Plastic and Hand Surgery, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Insitute of Health, 13353 Berlin, Germany
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Mansour AM, Jacobs A, Raj MS, Lee FG, Terrasse W, Wallace SJ, Miller NF. Lower Extremity Soft Tissue Reconstruction Review Article. Orthop Clin North Am 2022; 53:287-296. [PMID: 35725037 DOI: 10.1016/j.ocl.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reconstruction plays a valuable role in the management of lower extremity wounds for limb salvage. The goals of reconstruction are to improve function and quality of life, return to work, and pain reduction while providing a long-lasting durable reconstruction. The plastics and reconstructive surgical approach in conjunction with the orthopedic or trauma team, referred often as the "orthoplastic" approach, can yield the best outcomes for patients. The following sections discuss reconstruction principles and techniques that can be applied broadly for lower extremity wounds secondary to trauma, infection, and tumor resection.
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Affiliation(s)
- Ahmed M Mansour
- Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA.
| | - Aaron Jacobs
- Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA
| | - Mamtha S Raj
- Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA
| | - Frank G Lee
- University of South Florida Morsani College of Medicine, 2049 Street Wood Street, Allentown, PA 18103, USA
| | - Weston Terrasse
- Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA
| | - Sean J Wallace
- Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network, 3701 Corriere Road, Suite 15, Easton, PA 18045, USA
| | - Nathan F Miller
- Division of Plastic and Reconstructive Surgery, Lehigh Valley Health Network, 1250 South Cedar Crest Boulevard, Allentown, PA 18103, USA
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Kaura A, Fahrenkopf MP, Do VH. Heel Reconstruction Utilizing the Medial Plantar Artery Flap. EPLASTY 2022; 22:ic8. [PMID: 35706825 PMCID: PMC9181864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Arminder Kaura
- Michigan State University College of Human Medicine, Grand Rapids, MI
- Spectrum Health/Michigan State University Plastic and Reconstructive Surgery Residency, Grand Rapids, MI
| | - Matthew P Fahrenkopf
- Michigan State University College of Human Medicine, Grand Rapids, MI
- Spectrum Health/Michigan State University Plastic and Reconstructive Surgery Residency, Grand Rapids, MI
| | - Viet H Do
- Michigan State University College of Human Medicine, Grand Rapids, MI
- Spectrum Health/Michigan State University Plastic and Reconstructive Surgery Residency, Grand Rapids, MI
- Orthopaedic Associates of Michigan, Grand Rapids, MI
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Breidung D, Fikatas P, Mandal P, Berns MD, Barth AA, Billner M, Megas IF, Reichert B. Microsurgical Reconstruction of Foot Defects: A Case Series with Long-Term Follow-Up. Healthcare (Basel) 2022; 10:healthcare10050829. [PMID: 35627966 PMCID: PMC9141605 DOI: 10.3390/healthcare10050829] [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: 03/03/2022] [Revised: 04/13/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Microsurgical reconstruction of foot defects with free flaps is rare as it is a challenging task for a surgeon. For extensive defects, advanced surgical procedures, such as free flap transfer with microsurgical anastomosis, may be the last chance to avoid major amputation. The aim of the study was to examine the opportunities and risks posed by free flap reconstruction of foot defects and to illustrate in which situations reconstruction is useful on the basis of case characteristics. (2) Methods: In this study, we retrospectively analyzed data of cases with free flap reconstruction of the foot from 2007 to 2022. Therefore, demographic data, comorbidities, information about the defect situation, data on the operational procedure, and complications were evaluated. (3) Results: A total of 27 cases with free flap coverage of foot defects could be included. In 24 of these cases (89%), defect coverage was successful. In 18 patients, some form of complication occurred in the postoperative stage. The most frequently used flap was the latissimus dorsi flap, with 13 procedures. (4) Conclusions: Foot reconstruction using free flaps is a proven procedure for the treatment of larger foot defects and can offer a predominantly good functional outcome. The lengthy process and possible complications should be thoroughly discussed in advance so as to provide criteria, suitably adjusted to the individual prerequisites of the patients, for deciding whether limb salvage using advanced surgical procedures should be attempted.
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Affiliation(s)
- David Breidung
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
| | - Panagiotis Fikatas
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Patrick Mandal
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
- Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Maresa D. Berns
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
| | - Andrè A. Barth
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
| | - Moritz Billner
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
| | - Ioannis-Fivos Megas
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
- Correspondence: ; Tel.: +49-911-3982367
| | - Bert Reichert
- Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries, Paracelsus Medical University, Klinikum Nürnberg, Breslauer Str. 201, 90471 Nuremberg, Germany; (D.B.); (P.M.); (M.D.B.); (A.A.B.); (M.B.); (B.R.)
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Zhou J, Zhang X, Zhang Y, Wang W, Xu Y. Reconstruction of complex plantar forefoot defects using free tissue flaps combined with contralateral instep thick skin grafts. J Orthop Surg (Hong Kong) 2022; 30:10225536221094258. [PMID: 35404723 DOI: 10.1177/10225536221094258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the clinical efficacy of using free tissue flap combined with contralateral instep thick plantar skin in reconstructing complex plantar forefoot defects. METHODS During the past 8 years, 15 patients, aged 25-60 years, with defects in the soft-tissue and composite bone of the forefoot were treated. Their defects were caused by trauma. These defects were all located on the plantar forefoot. The free tissue flaps transposed to reconstruct defects were anterolateral thigh flaps, groin flaps, and latissimus dorsi flaps. Flap size varied in width 4-cm and length (6-16 cm). The mean size of flaps was 80.3 cm2. The follow-up period ranged from 12 to 90 months (mean, 25.5 months). RESULTS Partial flap loss was observed in one anterolateral thigh flap and one latissimus dorsi flap. One patient showed skin graft loss at the defect site, and the wound was re-epithelialized by changing dressings. Hyperkeratosis was not observed in any of the cases. All patients were able to walk near-normally within 2.5 months after surgery, and there was no recurrence of ulceration. CONCLUSION We advocate using a free tissue flap combined with contralateral instep thick plantar skin for reconstruction of moderate or large complex plantar forefoot defects.
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Affiliation(s)
- Jiandong Zhou
- Department of Foot and Ankle, 74735Wuxi NO.9 People's Hospital Affiliated to Soochow University, Wuxi, P. R. China
| | - Xingfei Zhang
- Department of Foot and Ankle, 74735Wuxi NO.9 People's Hospital Affiliated to Soochow University, Wuxi, P. R. China
| | - Yuxuan Zhang
- Department of Foot and Ankle, 74735Wuxi NO.9 People's Hospital Affiliated to Soochow University, Wuxi, P. R. China
| | - Wencheng Wang
- Department of Foot and Ankle, 74735Wuxi NO.9 People's Hospital Affiliated to Soochow University, Wuxi, P. R. China
| | - Yajun Xu
- Department of Foot and Ankle, 74735Wuxi NO.9 People's Hospital Affiliated to Soochow University, Wuxi, P. R. China
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Foot Wounds and the Reconstructive Ladder. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3989. [PMID: 34966631 PMCID: PMC8710339 DOI: 10.1097/gox.0000000000003989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
Background: Foot soft tissue coverage represents a challenge to reconstructive surgeons due to a lack of donor sites for this specialized skin. This glabrous tethered thick skin is designed to withstand weight bearing stress and is hard to replace. The limited arch of rotation of foot local flaps contributes to further difficulties. In this study, we share our experience in foot soft tissue loss coverage using techniques tailored to each wound presentation. Methods: This case series presents eight patients with wounds of the plantar and dorsal surfaces of the foot, heel, and ankle. Closure techniques were selected and planned based on wound presentation and comorbidity status. Results: Patients’ mean age at surgery was 61 years. Etiologies of wounds include trauma, frostbite, diabetic ulceration, malignancy, pressure ulcer with osteomyelitis, and necrotizing infection. Coverage techniques included split and full-thickness skin graft, medial plantar arch pinch graft, cultured epithelial autograft, Hyalomatrix wound device, EpiFix tissue matrix, pedicle flap, and free rectus flap. Complete soft tissue coverage was achieved in each case within reasonable postoperative periods, and ambulation was preserved and/or restored. Conclusions: Foot soft tissue reconstruction is challenging and should be planned carefully due to the required specialized skin replacement. Primary closure should be considered first and attempted if possible. Technique escalation in accordance with the reconstructive ladder should be undertaken based on wound etiology, presentation, amount and nature of tissue loss, available resources, and surgeon experience.
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13
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Msemwa JR, Mweya CN. A case report of a reverse sural flap for posterior ankle soft-tissue defect following an injury in a patient from Tanzania. SAGE Open Med Case Rep 2021; 9:2050313X211060685. [PMID: 34888053 PMCID: PMC8649446 DOI: 10.1177/2050313x211060685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
In the treatment and management of severe wounds, microsurgical repair remains the gold
standard. However, it is difficult to transfer free tissue from a Tanzanian perspective
due to donor site morbidity, longer operational times, bulky forms, recipient vessel
stress, sophisticated surgical expertise, and high costs of the equipment. Meanwhile, the
reverse sural flap has been considered as the ultimate tissue restoration technique. This
study reviews a case of a 35-year-old man who was admitted at Mbeya Zonal Referral
Hospital in the Department of Orthopaedics, Trauma, and Neurosurgery in Mbeya, Tanzania.
The patient had a 9-day injury to the rear of his right ankle due to a cut he suffered
after tripping over a toilet seat in the washroom. After the diagnosis, the plan involved
surgical debridement, tendon repair, and reverse sural flap rotation. Despite the
difficult working environment requiring advanced learning experience, our patient fully
recovered after 3 weeks. Proving that reverse sural flap is one of the few available
possibilities in the protection of vital structures such as bone or tendons, in the distal
areas of the leg, ankle, and foot especially when the medical treatment facility lacks a
strong microsurgery team and equipment.
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Affiliation(s)
- Joseph R Msemwa
- Department of Orthopaedics, Trauma and Neurosurgery, Mbeya Zonal Referral Hospital, Mbeya, Tanzania.,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Clement N Mweya
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.,Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
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14
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Feng B, Dai GM, Wang YJ, Zhang L, Niu KC. The Treatment Experience of Different Types of Flaps for Repairing Soft Tissue Defects of the Heel. Int J Gen Med 2021; 14:8445-8453. [PMID: 34819752 PMCID: PMC8608019 DOI: 10.2147/ijgm.s329642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To summarize the clinical application effects of three different types of flaps for repairing soft tissue defects of the heel, and to discuss the importance of tissue repair and heel reconstruction. Methods A total of 46 cases with skin tissue defects of the heel with deep tissue exposure were treated. The reasons for the defect were trauma (n = 26), burns and electric shocks (n = 12), chronic ulcers (n = 2), postoperative infection of the calcaneus and Achilles tendon (n = 5), and tumor resection (n = 1). The scope of wound defect was 2.0×2.5 to approximately 15.0×20.0 cm. The flaps used were medial plantar island flaps (n = 9), distal pedicled sural neurovascular island flaps (n = 23), and free anterolateral thigh (perforator) flaps (n = 14). The flap cutting range was 3.0×3.5 to approximately 16.0×22.0 cm. Results After surgery, all 46 flaps survived. In two cases, patients experienced partial epidermal necrosis at the distal end of the flap that healed after local dressing exchange, and after this treatment, the complete skin grafts survived. Follow-up was conducted in 40 cases, with an average follow-up duration of 8.2 months (3-44 months) and the two-point discrimination of 5-14 mm. The average American Orthopaedic Foot and Ankle Society scale was 89.2 points with good flap color and texture, satisfactory appearance, and normal gait. Conclusion The repair method should be selected according to the"5-zone method": The plantar medial island flap is suitable for small area (<5 cm) of medial, posterior and plantar defects. The distal pedicled sural neurovascular flap is suitable for lateral, posterior, and medium-range (6-10 cm) joint area defects. The free anterolateral thigh perforator flap is suitable for large-scale (>10 cm) joint area defects.
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Affiliation(s)
- Bo Feng
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Guang-Ming Dai
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Yong-Jun Wang
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Lan Zhang
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
| | - Ke-Cheng Niu
- Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China
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15
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Vasella M, Guidi M, Waldner M, Calcagni M, Giovanoli P, Frueh FS. Fluorescence angiography-assisted debridement of critically perfused glabrous skin in degloving foot injuries: Two case reports. Medicine (Baltimore) 2021; 100:e26235. [PMID: 34087908 PMCID: PMC8183782 DOI: 10.1097/md.0000000000026235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion. PATIENT CONCERNS Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin. DIAGNOSIS Clinical inspection revealed significant degloving of the glabrous skin in both patients. INTERVENTIONS After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed. OUTCOMES In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation. LESSONS ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.
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16
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Fodor MM, Fodor L. Simultaneous femoro-popliteal artery bypass and foot free flap for lower limb salvage: a 13-year follow-up. J Int Med Res 2021; 49:3000605211012607. [PMID: 33983061 PMCID: PMC8127790 DOI: 10.1177/03000605211012607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Critical limb ischemia (CLI) associated with lower extremity complex wounds is challenging for vascular and plastic surgeons. Despite a high risk of perioperative morbidity, complex reconstructive surgery in these patients is an alternative to primary major limb amputation. We present a patient with CLI and a complex foot wound treated with simultaneous femoro-popliteal arterial bypass and free flap for lower limb salvage. The 13-year follow-up showed good functional results.
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Affiliation(s)
- Marius M Fodor
- Department of Vascular Surgery, Emergency District Hospital, Cluj-Napoca, Romania
| | - Lucian Fodor
- Department of Plastic Surgery, Emergency District Hospital, Cluj-Napoca, Romania
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17
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Free Medial Plantar Flap Versus Free Dorsal Myocutaneous Flap for the Reconstruction of Traumatic Foot Sole Defects. Ann Plast Surg 2021; 84:S178-S185. [PMID: 32294068 DOI: 10.1097/sap.0000000000002373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trauma can cause large defects in the weight-bearing foot sole. The reconstruction of such defects poses a major challenge in providing a flap that is durable, sensate, and stable. The pedicled medial plantar flap has been commonly used for reconstructing heel and plantar forefoot defects; however, the ipsilateral instep region is usually compromised by trauma. The purpose of this article was to report the use of contralateral free medial plantar flaps for the coverage of weight-bearing plantar defects and to compare these with distant free flaps. METHODS Between 2005 and 2019, 15 patients (10 men and 5 women) with weight-bearing foot plantar defects were treated with a contralateral medial plantar flap, 11 (7 men and 4 women) with either a latissimus dorsi flap or a scapular flap. The average age was 18.07 ± 10.14 years (range, 4-34 years) and 26.55 ± 13.05 years (range, 13-56 years), respectively. Surgery was performed as a primary or secondary reconstruction after a trauma by the same surgical team. RESULTS The mean size of defects was 9.73 ± 3.55 × 6.43 ± 2.8 cm in the contralateral free medial plantar flap group and 17.14 ± 6.84 × 11.41 ± 4.29 cm in the free dorsal flap group. All flaps survived in both groups. In the instep flap group, the appearance was satisfactory, the flap was durable, and tactile sensation was preserved in all patients, and none required a revision procedure. Two patients experienced delayed union of the donor-site grafted skin. In the dorsal flap group, 5 patients complained of a partial necrosis or delayed union at the recipient site, and 9 developed recurrent ulcerations over the weight-\bearing area. Five patients achieved only partial sensation in the flap. CONCLUSIONS The contralateral medial plantar flap provides superior appearance, duration, and sensation over distant muscle flaps, without recurrent ulcerations. However, dorsal myocutaneous flaps may be used as a substitute when the defects are beyond the maximum boundaries of the instep area or are combined with bone loss.
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Parikh RP, Ha A, Tung T. Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes. J Reconstr Microsurg 2021; 37:783-790. [PMID: 33853128 DOI: 10.1055/s-0041-1727187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. METHODS This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated. RESULTS Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years. CONCLUSION Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.
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Affiliation(s)
- Rajiv P Parikh
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, District of Columbia
| | - Austin Ha
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas Tung
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
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19
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Kim JH, Yoo H, Eun S. Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap. INT J LOW EXTR WOUND 2021; 21:601-608. [PMID: 33626958 DOI: 10.1177/1534734620982238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The anterolateral thigh flap is a classic flap used for various reconstruction defects. However, the flap viability of extended large skin paddles (ie, 240 cm2) was doubted by many surgeons. This study reports successful experience of reconstructing extensive soft tissue defects of lower extremity using extended large skin paddles. Twelve consecutive patients who had undergone reconstruction of defects using an extended anterolateral thigh flap were identified. Patient characteristics (age, sex, defect location, injured structures, and type of flap) and outcome data were analyzed retrospectively. One artery and 2 accompanying veins were anastomosed to vascularize each flap. Follow-up periods ranged from 10 to 91 months postoperatively. The average size of the flaps was 268.75 cm2 (range = 220-391 cm2). All flaps were perforator flaps with one perforator except that 2 perforators were used in 3 patients. Two patients suffered partial flap necrosis of the distal portion with delayed healing. In conclusion, the extended anterolateral thigh flap is a considerable option for massive defects requiring composite tissue coverage. This flap is advantageous for reconstructing various complex defects in the lower extremities, providing a pliable and vascularized tissue to cover exposed extensive defects including tendons, nerves, and bones.
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Affiliation(s)
- Jong-Ho Kim
- Seoul National University, Seoul, Republic of Korea.,Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyokyung Yoo
- Seoul National University, Seoul, Republic of Korea.,Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seokchan Eun
- Seoul National University, Seoul, Republic of Korea.,Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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20
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Tsuihiji K, Daniel BW, Kageyama T, Sakai H, Fuse Y, Tsukuura R, Yamamoto T. Free tensor fascia lata true-perforator flap transfer for reconstruction of the calcaneal soft tissue defect complicated with osteomyelitis in a patient with alcohol-induced Charcot foot: A case report and literature review. Microsurgery 2021; 41:473-479. [PMID: 33595121 DOI: 10.1002/micr.30724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 11/07/2022]
Abstract
Charcot foot is can result in bone deformities and soft tissue defects. We report a case of alcohol-induced Charcot (AIC) foot with soft tissue defect including the weight-bearing zone of the heel and osteomyelitis, which was successfully reconstructed with free tensor fascia lata true-perforator flap (TFLtp). A 56-year-old male suffered from AIC foot with an 18 × 6 cm defect. Based on the preoperative ultrasound, we identified the overlying upper thigh area offering one of the thickest dermis. A TFLtp flap was raised sparing the TFL muscle based on one perforator without including the main trunk of the transverse/ascending branch of the lateral femoral circumflex vessel. The TFLtp flap was transferred to the heel and anastomosed to the posterior tibial artery in an end-to-side fashion. The patient complained no postoperative discomfort of the donor site and was able to walk on his foot after 5 weeks. This case report highlights that the TFLtp flap may offer thick dermis, faster surgery due to perforator level dissection and a concealed donor site.
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Affiliation(s)
- Kanako Tsuihiji
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Bassem W Daniel
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Kageyama
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hayahito Sakai
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuma Fuse
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Tsukuura
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takumi Yamamoto
- Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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21
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Zhou LL, Wei JW, Peng P, Liu LH, Yin CD, Luo ZB, Tao SB, Dong ZG. Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps. J Reconstr Microsurg 2021; 37:580-588. [PMID: 33592636 DOI: 10.1055/s-0041-1723817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study is to describe the distribution of natural true anastomoses associated with the distally based perforator-plus sural neurocutaneous flap (sural flap), summarize our experience in the flap with high pivot point, and compare the outcomes between the flaps with high and low pivot points. METHODS Five amputated lower limbs were perfused, and the integuments were radiographed. We retrospectively analyzed 378 flaps, which were divided into two groups: pivot points located ≤8.0 cm (low pivot point group) and >8.0 cm (high pivot point group) proximal to the tip of the lateral malleolus. Partial necrosis rates were compared between two groups. RESULTS The arterial chain surrounding the sural nerve was linked by true anastomoses from the intermalleolar line to popliteal crease. True anastomoses existed among peroneal perforators and between these perforators and the arterial chain. There were 93 flaps with high pivot point and 285 flaps with low pivot point. Partial necrosis rates were 16 and 9.1% in the high and low pivot point group (p = 0.059), respectively. CONCLUSION True anastomosis connections among peroneal perforators and the whole arterial chain around sural nerve enable the sural flap to survive with a greater length. The sural flap with high pivot point is a good option for reconstructing soft-tissue defects in the middle and distal leg, ankle, and foot, particularly when the lowest peroneal perforator presents damage, greater distance to the defects, discontinuity with the donor site, or anatomical variation.
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Affiliation(s)
- Ling-Li Zhou
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jian-Wei Wei
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Ping Peng
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Li-Hong Liu
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Chao-Dong Yin
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhao-Biao Luo
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shi-Bin Tao
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhong-Gen Dong
- Department of Orthopedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Treatment of traumatic losses of substance in the foot. ANN CHIR PLAST ESTH 2020; 65:549-569. [PMID: 32753248 DOI: 10.1016/j.anplas.2020.06.010] [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: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022]
Abstract
Treatment of traumatic loss of bone and tissue substance in the foot necessitates special consideration of the anatomy and physiology of the segment. The causes of foot trauma are multiple and in many cases violent, leading to progressive tissue deterioration that may require multi-phased debridement. The therapeutic objective is to reconstruct a functional foot permitting painless pushing off, walking and footwear use by restoring a stable bone framework, with resistant covering satisfactorily adjusted to the different zones of the foot. While coverage of the back of the foot must be fine, coverage of the plantar zones will be padded. The reconstructive surgeon shall be particularly attentive to plantar sensitivity. To take up the surgical challenge, it is of paramount importance to fully master a wide-ranging therapeutic arsenal ranging from conventional grafts to composite free flaps in view of proposing the solution most suited to the type, size and location of the loss of substance, all the while striving to generate as few sequelae as possible at the donor site. In order for reconstruction to be successful, multidisciplinary collaboration between plastic surgeons, orthopedists and physician is highly recommended.
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Discussion: Strategies for Reconstruction of the Plantar Surface of the Foot: A Systematic Review of the Literature. Plast Reconstr Surg 2019; 143:1245-1246. [PMID: 30921150 DOI: 10.1097/prs.0000000000005491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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