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Bernuth S, Panayi AC, Didzun O, Knoedler S, Matar D, Bigdeli AK, Falkner F, Kneser U, Orgill DP, Jakubietz RG, Hundeshagen G. A nomogram for predicting outcomes following pedicled flap reconstruction of the lower extremity. J Plast Reconstr Aesthet Surg 2024; 96:13-22. [PMID: 39013259 DOI: 10.1016/j.bjps.2024.05.024] [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: 01/15/2024] [Revised: 05/05/2024] [Accepted: 05/24/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Lower extremity reconstructions with soft tissue flaps account for a significant proportion of reconstructive surgery. Pedicled flaps are a procedure of choice, particularly in multimorbid patients and those with small to medium-sized defects. Complication rates are high and should not be underestimated, with accurate preoperative risk factor assessment being imperative. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program Database (2008-2021), we analyzed all patients who underwent pedicled flap reconstruction of the lower extremity. Demographic data, comorbidities, and perioperative data were extracted. We identified risk factors of major surgical complications within 30 days of surgery through uni- and multivariate regression analyses. On this basis, a nomogram for predicting the risk of complications was developed to allow for feasible point-of-care risk assessment. RESULTS A total of 6475 adult patients were identified. The most common comorbidities were hypertension (n = 3363, 51.9%) and obesity (n = 2306, 35.6%) and most common American Society of Anesthesiologists (ASA) class was class 3 (n = 3703, 57.2%). The most common complication was bleeding/transfusion (n = 1293, 19.9%). Multivariate regression revealed longer procedures, inpatient setting, higher ASA scores, hypertension, and procedures performed by orthopedic and vascular surgeons as predictors for higher risk of post-operative complications. CONCLUSION Leveraging a risk- and case-mix-adjusted multi-institutional database, a nomogram for post-operative surgical complications within 30 days after pedicled flap reconstruction in the lower extremity was developed. This broadly applicable risk prediction tool can aid in decision-making when assessing patient eligibility.
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Affiliation(s)
- Silvia Bernuth
- Department of Plastic and Reconstructive Surgery, Clinic of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Oliver Didzun
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dany Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafael G Jakubietz
- Department of Plastic and Reconstructive Surgery, Clinic of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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de Villeneuve Bargemon JB, Witters M, Van Straaten G, Brenac C. Reply to: Revisiting Bipedicled Flaps for Lower Extremity Distal Third Defects: How Can We Better Describe and Localize Soft-Tissue Defects in the Distal Third of the Leg? Ann Plast Surg 2024; 92:340-342. [PMID: 38320004 DOI: 10.1097/sap.0000000000003788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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Matuszewski PE, Ulrich GL. How to get the most out of your gastrocnemius and soleus flaps. OTA Int 2023; 6:e255. [PMID: 37448570 PMCID: PMC10337844 DOI: 10.1097/oi9.0000000000000255] [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: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 07/15/2023]
Abstract
Gastrocnemius and soleus flaps represent the workhorse local flaps to cover soft tissue defects of the proximal 1/3 and middle 1/3 of the leg, respectively. An important consideration before conducting a local flap is whether the flap can provide adequate coverage. The utility of the gastrocnemius flap can be increased using multiple techniques to increase the arc of rotation including the posterior midline approach, dissection at the pes anserinus and medial femoral condyle origin, scoring the fascia, and inclusion of a skin paddle. Concerning the soleus flap, the hemisoleus flap represents a technique to increase the arc of rotation. With a soleus flap, one must consider the soft tissue defect location, size, and perforator blood supply because these factors influence what soleus flap technique to use. This article discusses how to make the most out of gastrocnemius flaps and soleus flaps regarding maximizing coverage and ensuring successful flap outcome.
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Affiliation(s)
- Paul E. Matuszewski
- Corresponding author. Address: Paul E. Matuszewski, MD, Department of Orthopaedic Surgery and Sports Medicine, Kentucky Clinic, 740 S. Limestone, Suite K401, Lexington, KY 40536-0284. E-mail:
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Blair JA, Puneky GA, Dickerson TE, Faith HD, Davis JM. Posttraumatic Soft Tissue Coverage of the Lower Leg for the Orthopedic Surgeon. Orthop Clin North Am 2022; 53:297-310. [PMID: 35725038 DOI: 10.1016/j.ocl.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Soft tissue reconstructive techniques are powerful tools for the orthopedic surgeon caring for lower extremity trauma. This article seeks to inform orthopedic surgeons about useful techniques for skin closure, secondary wound closure techniques, and rotational flaps of the lower leg. Split thickness skin grafting, piecrusting, and the use of negative pressure wound therapy for skin closure, as well as rotational gastrocnemius, soleus, and reverse sural artery flaps are discussed with emphasis on techniques for the nonvascular and nonmicrovascular orthopedic surgeon.
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Affiliation(s)
- James A Blair
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA.
| | - George A Puneky
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA
| | - Thomas E Dickerson
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Hayden D Faith
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Jana M Davis
- Department of Orthopedic Surgery, Medical College of Georgia at Augusta University, 1120 15th St., BA 3300, Augusta, GA 30912, USA. https://twitter.com/janadavisMD
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Kondra K, Roohani I, Swerdlow M, Brown M, O'Brien D, Pekcan A, Stanton E, Carey J. "Outcomes of Local versus Free Flaps for Lower Extremity Trauma". Am Surg 2022; 88:2544-2550. [PMID: 35581551 DOI: 10.1177/00031348221103651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lower extremity reconstruction often requires soft tissue transfer for limb salvage. Flaps are allocated based on injury size, location, and shape coupled with surgeon expertise. Ideally, vascularized tissue should have similar outcomes across local and free tissue transfers. By evaluating outcomes from a Level 1 trauma center, we aim to provide recommendations regarding surgical management of leg reconstruction with respect to local versus free flap implementation. METHODS This retrospective review evaluated patient medical history, demographics, flap characteristics, and outcomes from LAC + USC between 2007-2021 using an internal database. Outcomes included failure rates, complications, and ambulation. RESULTS 357 lower extremity flaps were placed on 322 patients; 187 (52.4%) were local and 170 (47.6.%) were free flaps. Twenty-one (11.2%) local flaps suffered significantly more postoperative hardware infections and/or osteomyelitis compared to nine (5.3%) free flaps. Eleven (5.9%) local flaps developed partial necrosis, four requiring revision; 12 (6.4%) total local flaps required revision. Comparatively, sixteen (9.4%) free flaps developed partial necrosis, seven requiring revision; 18 (10.6%) total free flaps required revision. Flap survival was 96.3% for local versus 93.5% for free flaps. Percentage of fully ambulatory patients and time to final ambulation was not significant across cohorts. DISCUSSION Local flaps may portent higher risk for infection; though the cause is not clear, the results may be confounded by comorbidities. Nevertheless, there were no significant differences in flap survival or number of fully ambulatory patients across cohorts. Future studies should evaluate aesthetic results and patient satisfaction across flap types.
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Affiliation(s)
- Katelyn Kondra
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Idean Roohani
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Mark Swerdlow
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Michael Brown
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Devon O'Brien
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Asli Pekcan
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Eloise Stanton
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Joseph Carey
- Division of Plastic and Reconstructive Surgery, 12223Keck School of Medicine of USC, Los Angeles, CA, USA
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Grush AE, Depani M, Parham MJ, Mejia-Martinez V, Thornton A, Sammer DM. Use of Biologic Agents in Extremity Reconstruction. Semin Plast Surg 2022; 36:43-47. [PMID: 35706564 PMCID: PMC9192157 DOI: 10.1055/s-0042-1744282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractSkin and soft tissue defects of the lower extremity present a unique challenge for the reconstructive surgeon. Successful repair of the lower extremity relies not only on strong anatomical knowledge and surgical expertise, but also on careful consideration of the numerous preoperative factors and indications that may alter the patient's response to operative management. While many of these injuries result from burns, avulsive trauma, diabetes, or vascular insufficiencies, a significant portion can be associated with resection of neoplastic pathologies. This review outlines the uses, indications, and considerations for biologic wound agents in reconstructing skin and soft tissue defects of the lower extremity following Mohs micrographic surgery.
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Affiliation(s)
- Andrew E. Grush
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew J. Parham
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Valeria Mejia-Martinez
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexandra Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Douglas M. Sammer
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Ferry AM, Gimenez AR, Abu-Ghname A, Xue EY, Pederson WC, Lazo DÁA, Maricevich M. Reconstruction of Complex Lower Extremity Defects. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Perforator-based Adipofascial Flaps and ADM: A Novel Combined Approach to Distal Lower Extremity Defects. Plast Reconstr Surg Glob Open 2022; 10:e4131. [PMID: 35198355 PMCID: PMC8856593 DOI: 10.1097/gox.0000000000004131] [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: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
Due to the wide spectrum of lower extremity defect presentation, various reconstructive techniques are available. Classic adipofascial flaps are still a second choice. The authors described a new multistage reconstructive approach with perforator-based pedicled adipofascial flap.
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Zeiderman MR, Pu LLQ. Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma. BURNS & TRAUMA 2021; 9:tkab024. [PMID: 34345630 PMCID: PMC8324213 DOI: 10.1093/burnst/tkab024] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/22/2021] [Indexed: 11/29/2022]
Abstract
The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care, soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review, the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity, as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction, timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed, notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed, as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium. Finally, the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds. Upon completion of this review, the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.
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Affiliation(s)
- Matthew R Zeiderman
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
| | - Lee L Q Pu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, Davis, Sacramento, CA, USA
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Jitprapaikulsarn S, Patamamongkonchai C, Gromprasit A, Thremthakanpon W. Simultaneous internal fixation and soft tissue coverage by soleus muscle flap and variances: a reproducible strategy for managing open fractures of tibial shaft. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:365-373. [DOI: 10.1007/s00590-020-02786-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/01/2020] [Indexed: 12/01/2022]
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Jitprapaikulsarn S, Benjawongsathien K, Patamamongkonchai C, Gromprasit A, Thremthakanpon W. Combined medial gastrocnemius and hemisoleus flap: a reproducible alternative for open tibial fractures complicated with large or double soft tissue defects. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:413-420. [DOI: 10.1007/s00590-020-02772-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
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Bulla A, Delgove A, De Luca L, Pelissier P, Casoli V. The esthetic outcome of lower limb reconstruction. ANN CHIR PLAST ESTH 2020; 65:655-666. [PMID: 32800462 DOI: 10.1016/j.anplas.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In recent years, the progress of anatomical knowledge and microsurgical techniques, in particular the development of perforator flaps, has risen the number of flaps available for lower leg reconstruction. The esthetic consequences of flap choice and harvest do have an impact on patients' quality of life. Nowadays, more researchers evaluate the esthetic changes following lower limb reconstruction. OBJECTIVES This review aims to summarize the available evidence on the esthetic outcome of lower limb reconstruction. DATA SOURCES A systematic review was planned to identify the most relevant indexed articles on this subject. The search was performed on Pubmed database without date of publication limits. STUDY ELIGIBILITY CRITERIA All papers about reporting information about the esthetic outcome of lower limb reconstruction were selected. Case reports and the articles not including specific information about complications, secondary procedures, and outcomes were excluded. The articles were categorized according to their topic and date of publication. The full texts of all the articles were obtained and read thoroughly. The references for each article were screened to identify articles that were eventually left outside our database search. PARTICIPANTS, AND INTERVENTIONS One hundred and eight articles were retained for the definitive review. Eleven review articles were kept because they represented a good source of information. Thirty-three articles were added after reading the full texts. The articles appear highly heterogeneous and at, this stage, only a critical and qualitative analysis could be performed. RESULTS We found information about 7895 lower reconstructions, 1295 local flaps, 6546 free flaps. LIMITATIONS The esthetic evaluation is intrinsic subjective. Many psychological and cultural factors influence both the patient and the surgeon. There is not a validated assessment tool for the esthetic outcome of lower leg reconstruction. Therefore, no quantitative analysis was performed. CONCLUSIONS Some ancient techniques are today obsolete, like the rectus abdominis free muscle flaps and perhaps free forearm flap, others are always useful, like gracilis and latissimus dorsi free flap. ALT flap is the most versatile perforator flap today available, but the SCIP flap is gaining the favor of a growing number of surgeons. Local flaps will be always performed with success but their indications should not be pushed beyond the medium-size defects. The best cosmetic outcome for each patient cannot necessarily be obtained neither with the easiest techniques nor with the most technically demanding ones. It is necessary to develop validated tools to assess the cosmetic outcome of lower limb reconstruction.
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Affiliation(s)
- A Bulla
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - A Delgove
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - L De Luca
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - P Pelissier
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - V Casoli
- Department of Plastic and Reconstructive Surgery, Hand Surgery, Burns Unit, F.X.-Michelet Center, University Hospital Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Best Local Flaps for Lower Extremity Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2774. [PMID: 32440438 PMCID: PMC7209892 DOI: 10.1097/gox.0000000000002774] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 02/24/2020] [Indexed: 12/05/2022]
Abstract
Supplemental Digital Content is available in the text. The ideal reconstruction of lower limb defects should replace like with like and minimize morbidity to the donor site, achieving the best possible esthetic and functional outcome. The goal is to obtain stable healing and to resume daily life in an efficient manner. Although the classical local flaps such as gastrocnemius, soleus muscle flap, and the reverse sural flap have allowed to achieve those goals, perforator flaps are now added on to the armamentarium in lower extremity reconstruction using local flaps. A perforator-based local flap, such as a propeller or keystone flap, has made reconstruction efficient while further reducing donor-site morbidity. This article aims to provide a useful review of the best available local flaps for lower limb defects.
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Atia A, Vernon R, Pyfer BJ, Shammas RL, Hollenbeck ST. The Essential Local Muscle Flaps for Lower Extremity Reconstruction. J Reconstr Microsurg 2020; 37:89-96. [PMID: 32303104 DOI: 10.1055/s-0040-1709480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lower extremity reconstruction is often a challenging prospect with major implications on a patient's quality of life. For complex defects of the lower extremity, special consideration must be given to ensure suitable and durable coverage. In the following article, we present the essential local muscle flaps for lower extremity reconstruction and discuss guiding principles for the reconstructive surgeon to consider. METHODS A thorough literature review was performed using PubMed to identify commonly used local muscle flaps for lower extremity reconstruction. Common considerations for each identified flap were noted. RESULTS The essential local muscle flaps for lower extremity reconstruction were identified and classified based on anatomical region of the defect to be reconstructed. General considerations and postoperative management were discussed to aid in operative decision making. CONCLUSION While many factors must be taken into account when performing lower extremity reconstruction, there are numerous reliable local muscle flaps which can be used to successfully provide durable coverage for a variety of soft tissue defects of the lower extremity.
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Affiliation(s)
- Andrew Atia
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
| | - Rebecca Vernon
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Bryan J Pyfer
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ronnie L Shammas
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina
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Bejinariu CG, Marinescu SA. Lower Limb Salvage Using the Medial Hemisoleus Flap Associated with the Reverse Sural Flap. J Med Life 2020; 12:461-465. [PMID: 32025268 PMCID: PMC6993290 DOI: 10.25122/jml-2019-0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The paper aims to present the reconstructive surgical approach in the case of a patient with complex soft tissue lesions of the calf. The patient was the victim of a road accident resulting in the fracture of the right tibia for which screw-plate osteosynthesis was performed. The chosen therapeutic solution was represented by covering the soft tissue defects using a complex algorithm that involved the use of a reverse sural flap associated with a medial hemisoleus muscle flap and a split-thickness skin graft. Considering functional recovery and the degree of patient satisfaction, the result of the therapeutic conduct was appreciated as very good. The association of the reverse sural flap with the medial hemisoleus flap can be a solution for solving complex cases with multiple soft tissue defects located in the middle and lower third of the calf.
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Affiliation(s)
- Catalin Gheorghe Bejinariu
- Department of Plastic and Reconstructive Surgery, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania
| | - Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania
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