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LaValley MN, Dugue D, Diaddigo SE, Kuonqui KG, Tyler WK, Bogue JT. A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00001. [PMID: 38421606 PMCID: PMC10906598 DOI: 10.5435/jaaosglobal-d-23-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The orthoplastic approach to patient care has changed the way patients with a wide variety of lower extremity pathology are treated. Through a systematic review, we aim to analyze outcomes in adult patients with lower extremity soft tissue sarcomas who undergo an orthoplastic flap management approach to their care. METHODS A systematic review of adult lower extremity soft tissue sarcoma excision with plastic surgery flap reconstruction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching the Pubmed, Embase, and Web of Science databases from inception to April 2023. RESULTS After removal of duplicates, title and abstract screening, and full-text review, 26 articles were accepted for inclusion. The total mean follow-up duration was 32.0 ± 24.3 months. Reconstruction used microvascular free flaps in 65.5% (487/743), while 34.5% (256/743) were local flaps. 85.8% (307/358) of patients ambulated postoperatively. Revision surgery was required in 21% of patients during their respective follow-up periods. The limb salvage rate was 93.4% (958/1,026). Among pooled surgical outcomes, 22.2% (225/1,012) of patients experienced a perioperative complication. DISCUSSION Our study demonstrates that although complication rates in lower extremity soft tissue sarcoma reconstruction may be further optimized, a multidisciplinary flap reconstructive approach provides high rates of limb salvage and functional postoperative ambulation.
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Affiliation(s)
- Myles N. LaValley
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - David Dugue
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Sarah E. Diaddigo
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Kevin G. Kuonqui
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Wakenda K. Tyler
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Jarrod T. Bogue
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
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Tsuha Y, Oshiro H, Mizuta K, Tamaki T, Tome Y, Wada N, Nishida K. Reconstruction of the lateral collateral ligament using the plantaris tendon after wide excision of soft tissue sarcoma of the knee: A case report. Mol Clin Oncol 2023; 18:23. [PMID: 36844466 PMCID: PMC9944641 DOI: 10.3892/mco.2023.2619] [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: 11/17/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
An 83-year-old woman presented with a 1-year history of a growing mass on the lateral surface of the right knee. Magnetic resonance imaging revealed a large soft tissue tumor in the subcutis of the right knee. The mass in the right knee rapidly increased, due to hemorrhage from the tumor. A needle biopsy revealed that the diagnosis was synovial sarcoma. The patient underwent wide excision and lateral collateral ligament reconstruction using the plantaris tendon. The patient had a Musculoskeletal Tumor Society Score of 86% at the lateset follow-up. In conclusion, reconstruction of the lateral collateral ligament using the plantaris tendon may be useful for preserving the function of the knee joint after resection of the soft tissue due to sarcoma of the knee.
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Affiliation(s)
- Yuichi Tsuha
- Department of Orthopedic Surgery, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Hiromichi Oshiro
- Department of Orthopedic Surgery, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kohei Mizuta
- Department of Orthopedic Surgery, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yasunori Tome
- Department of Orthopedic Surgery, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan,Correspondence to: Dr Yasunori Tome, Department of Orthopedic Surgery, Graduate School of Medicine, University of The Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
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Jeong SH, Baik SH, Namgoong S, Dhong ES, Han SK. An algorithmic approach to soft-tissue reconstruction around the knee using anterolateral thigh perforator flap in patients with post-traumatic knee osteomyelitis. Front Surg 2023; 10:982669. [PMID: 36814861 PMCID: PMC9939455 DOI: 10.3389/fsurg.2023.982669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023] Open
Abstract
Background Free tissue transfer to the knee region in patients with chronic post-traumatic knee osteomyelitis (CTKOM) poses a great challenge to surgeons because the remaining soft tissues adjacent to defects, including vascular structures, are usually damaged by chronic inflammation and multiple debridements. Thus, we developed an algorithm to help select the optimal recipient vessels and appropriate anterolateral thigh perforator (ALTP) flap type. In addition, we performed surgery using this algorithm and achieved successful reconstructions. This study aims to review our experiences in algorithmic reconstruction and assess its efficacy. Methods According to the defect size and location, our algorithm suggested the use of various-shaped ALTP flaps with centrally located perforators (Cen-ALTP flap) or eccentrically located perforators (Ecc-ALTP flap). Besides, through the algorithm, one recipient vessel was selected among three candidates, including descending branch of the lateral circumflex femoral artery (DB-LCFA), anterior tibial artery (ATA), and posterior tibial artery (PTA). Based on this algorithmic decision, we performed individualized soft tissue reconstructions of the knee in 21 patients with CTKOM, between March 2013 and June 2021. The medical records of the patients were retrospectively reviewed. Results The Cen-ALTP flap (n = 15) and ATA (n = 9) were the most commonly used for reconstruction. The Cen-ALTP flap anastomosed to the ATA was most commonly selected (n = 7) using the algorithm, followed by the Cen-ALTP flap anastomosed to the DB-LCFA (n = 5), and the Cen-ALTP flap anastomosed to the PTA (n = 3). All transferred ALTP flaps survived the follow-up period. Postoperative venous congestion in two patients and hematoma in one patient were resolved by immediate treatment. The postoperative course was uneventful. Conclusion During free ALTP flap transfer to CTKOM-related knee defects, we could select the optimal recipient vessel and appropriate flap type using our algorithm and obtain excellent reconstructive outcomes. Therefore, we believe that our algorithm could provide helpful guidance to reconstructive surgeons on free ALTP flap transfer to reconstruct CTKOM-related soft tissue defects.
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Gravvanis A, Kyriakopoulos A, Kateros K, Tsoutsos D. Flap reconstruction of the knee: A review of current concepts and a proposed algorithm. World J Orthop 2014; 5:603-613. [PMID: 25405089 PMCID: PMC4133468 DOI: 10.5312/wjo.v5.i5.603] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/20/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
A literature search focusing on flap knee reconstruction revealed much controversy regarding the optimal management of around the knee defects. Muscle flaps are the preferred option, mainly in infected wounds. Perforator flaps have recently been introduced in knee coverage with significant advantages due to low donor morbidity and long pedicles with wide arc of rotation. In the case of free flap the choice of recipient vessels is the key point to the reconstruction. Taking the published experience into account, a reconstructive algorithm is proposed according to the size and location of the wound, the presence of infection and/or 3-dimensional defect.
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Abstract
Microsurgical free tissue transfer is playing a critical role in reconstruction of the soft tissue around the knee to salvage the limb, especially when the defects exist with a wide zone of injury or with a poor soft tissue condition, where local flaps are unavailable. For a successful free flap transfer, proper selection of a recipient vessel is essential and challenging. The survival and other outcomes of the transferred flaps were closely related to which recipient vessel was used and the location of anastomosis. In this article, we review most of the clinical reports about using free flaps to reconstruct the soft tissue around the knee, excluding the cases of postamputation, and discuss about the recipient vessels that can be used.
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Schneider LF, Kaplan KA, Mehrara BJ. Pedicled peroneal artery flap for popliteal fossa reconstruction. J Plast Reconstr Aesthet Surg 2014; 67:282-4. [DOI: 10.1016/j.bjps.2013.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 11/15/2022]
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