The Coverage of Soft-Tissue Defects Around the Foot and Ankle Using Free or Local Flaps: A Comparative Cohort Study

Reconstruction of foot and ankle defects using the vaccum sealing drainage versus the induced-membrane the elderly: A retrospective comparative study

The purpose of this study was to compare the reconstructive outcomes of soft-tissue defects around foot and ankle with vaccum sealing drainage (VSD) or induction membrane (IM) of cement formation and attempt to provide an optimal strategy for elderly patients. A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from October of 2016 and October of 2020 was performed. Based on the different way, the patients were divided into two groups: VSD group (n = 26) and IM group (n = 27). Outcomes were assessed according to the size of the defect, frequency of debridement procedures, hospitalization time, duration of healing, the healing rate, major amputation rate, functional outcomes and complications. Immunohistochemistry (IHC) detection of vascular endothelial growth factor (VEGF) was also be completed. We found that there was no difference in demographic characteristics, size of the defect, debridement times and functional outcomes between the two groups (p > 0.05); however, a significant difference in the wound healing time, hospitalization time and complications were noted between them(p < 0.05). The fresh granulation tissue of both groups showed abundant positive expression of VEGF. Thus, the VSD and IM are both available for foot and ankle reconstruction in elderly patients. However, the IM group offers short hospitalization time, duration of healing and lower frequency of postoperative complications. Thus, we advocate the IM for reconstruction of defects of the foot and ankle region in the elderly patients.

The Subcalcaneal Fat Pad: An Innovative Space for Passage of the Pedicle in Free Flap Reconstruction of Lateral Heel Defects

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.

Fracture-Related infection - the role of the surgeon and surgery in prevention and treatment

Fracture-related infection (FRI) is a complication that impacts care costs, quality of life, and patient function. Great strides have been made in the last decade to obtain a common language for definition and diagnosis with the contribution of the Fracture-Related Infection Consensus. Although FRI treatment requires the participation of clinical specialists in infectious diseases for the management of antibiotics, it is necessary to understand that this complication is an eminently surgical pathology. The orthopedic surgeon must play a leadership role in the prevention and treatment of this complex disease. In this review, the most relevant aspects of prevention are updated, and a strategy for a sequential and comprehensive approach to the patient with this complication is presented.

Comparison of "complications" and functional outcome of anterolateral thigh flap and sural neurofasciocutaneus flap for foot and ankle reconstruction: A single center cohort study

BACKGROUND

Skin and soft-tissue defects around the foot and ankle remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh (ALT) flap and sural neurofasciocutaneous (NFC) flap are both used to reconstruct lower-extremity soft-tissue defects. The purpose of this study was to compare outcomes of the two flaps and attempt to provide an optimal strategy.

METHODS

A retrospective study was conducted, reviewing data from 93 patients who underwent reconstruction of wounds around the foot and ankle with ALT flap (42 cases) or NFC flap (51 cases) from January 2014 to January 2020. Patients' demographics, characteristics of the defect, complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed.

RESULT

There was no difference in gender and etiology; however, NFC flaps were more frequently used in elderly patients. Mean size of the flap in the ALT group was significantly larger in comparison with the NFC group. The ALT group had longer operation and hospitalization time than the NFC group (P < 0.05). The incidence of partial necrosis in ALT group was significantly lower than that in NFC group, while its general complications rate was higher. In long-term follow-up, esthetic appearance of the reconstructed site was comparable in both groups, the ALT group had a higher ratio of revision surgery. Moreover, the ALT group showed better overall esthetic outcomes in the donor site.

CONCLUSIONS

The study showed that anterolateral thigh flaps in wound coverage of foot and ankle achieved better outcomes than neurofasciocutaneous flaps in terms of recipient benefits and donor-site compromise with a special indication for larger and more distally located defects.

Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

Background: Free and pedicled flaps are both valuable surgical strategies for lower limb reconstruction. Evidence that compares both techniques is scarce. Our aim is to synthetise all the comparative studies by conducting a meta-analysis to identify post-operative outcomes. Method: A systematic review of pubmed, EMBASE, Cochrane library, and Web of Science was conducted, aiming at articles comparing the outcomes of free versus pedicled flaps in lower limb reconstruction. A pooled analysis with the Mantel and Haenszel methods and random effect analysis provided results as a risk ratio with a 95% confidence interval. Results: 10 retrospective studies were selected. While the flap necrosis rate did not differ significantly between techniques (RR 1.35, 95%CI 0.76–2.39, p = 0.31), the partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22–0.91, p = 0.03). The overall complication rate (RR 0.83, 95%CI 0.64–1.07, p = 0.16) and revision surgery rate (RR 1.38, 95%CI 0.55–3.50, p = 0.49) did not differ significantly. No significant difference was found in the high aesthetic satisfaction rate (RR 1.76, 95%CI 0.57–5.41, p = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55–1.33, p = 0.48). Conclusion: Despite important variability in the choice of flaps and outcomes reported among studies, free and pedicled flaps appear to be reliable surgical strategies for lower limb reconstruction with similar surgical outcomes.

Foot and ankle reconstruction using the lateral supramalleolar flap versus the anterolateral thigh flap in the elderly: A comparative study

The purpose of this study was to compare the reconstructive outcomes of soft‐tissue defects around the foot and ankle with anterolateral thigh (ALT) flap or lateral supramalleolar (LSM) flap and attempt to provide an optimal strategy for elderly patients. A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from October of 2010 and October of 2020 was performed. Based on the flap types, the patients were divided into two groups: ALT flap group (n = 50) and LSM flap group (n = 46). Outcomes were assessed according to the flap survival rate, early complications, general complications, late complications, cosmetic appearance, functional outcomes and Vancouver Scar Scale (VSS). We found that there was no difference in average age, gender, aetiology, size of the defect, debridement times between the two groups; however, a significant difference in operation time, hospitalisation time and cost were noted between them. What's more, the early flap complications between them were not significantly different. The LSM flap group showed less general complications, less flap bulky and lower cosmetic appearance. Moreover, the functional evaluation and VSS seem similar (P > .05). Thus, The ALT flap and LSM flap are both flaps available for foot and ankle reconstruction in elderly patients. However, the LSM flap offers short operation time, short hospitalisation time, and less cost with a lower frequency of postoperative complications. Thus, we advocate the LSM flap for the reconstruction of moderate‐size defects of the foot and ankle region in elderly patients.