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Island perforator muscle flaps for chronic osteomyelitis of the lower extremities: a retrospective analysis of 21 consecutive cases. Plast Reconstr Surg 2022; 150:677-687. [PMID: 35791262 DOI: 10.1097/prs.0000000000009472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND One of the procedures for treating chronic osteomyelitis is the management of dead space resulting from aggressive debridement of the marrow cavity. To fill the void created by debridement, various muscle flaps have been recommended by many surgeons for their convenience and anti-infective properties. The objective of our study was to evaluate the efficacy of island perforator muscle flaps for the reconstruction of chronic osteomyelitis debridement defects of the lower extremities and provide indications for the selection of the muscle flap. METHODS A retrospective review of consecutive patients with chronic osteomyelitis of the lower extremities who underwent reconstruction using the island perforator muscle flap procedure from 2015 through 2018 was conducted. Data were collected on characteristics of the patients, wound site, wound size, surgical procedure, muscle choice, and wound healing. RESULTS For the 21 patients included in the study, all muscle flaps survived. Wounds healed completely within 4 weeks. No infection relapses were identified during the follow-up period of at least 12 months. Simple primary closure, with no additional incision in the donor site, was achieved in five patients. In eight patients, an additional incision was made to harvest a muscle flap, but both the wound and donor site were closed primarily. CONCLUSIONS The results showed that the island perforator muscle flap is less invasive, easy to harvest, and effective, which can be a good choice for the management of dead space resulting from debridement for chronic osteomyelitis in the lower extremity.
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Zhang W, Zhu W, Li X, Li X, Li X. Effects of Distal Arterial Supercharging and Distal Venous Superdrainage on the Survival of Multiterritory Perforator Flaps in Rats. J INVEST SURG 2022; 35:1462-1471. [PMID: 35414343 DOI: 10.1080/08941939.2022.2063459] [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: 10/18/2022]
Abstract
BACKGROUND Which one of the two measures, distal arterial supercharging (DAS) and distal venous superdrainage (DVS), is better to enhance flap survival? No consistent conclusions have been reached. METHODS All flaps were pedicled on the deep circumflex iliac vessels. Seventy-two healthy male rats were distributed to four groups randomly: DAVS group (distal arteriovenous supercharging group), the thoracodorsal (TD) artery and TD vein were preserved; DAS group (distal arterial supercharging group), the TD vein was ligated; DVS group (distal venous superdrainage group), the TD artery was ligated; control group, the TD artery and TD vein were ligated. Flap survival rate was evaluated on postoperative day 7. Flap angiography was performed to assess vascular changes of the flap. Microvascular density (MVD) was evaluated by hematoxylin and eosin staining, and CD34-positive microvessel density was measured by immunohistochemistry. Vascular endothelial growth factor (VEGF) level was measured by western blot. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were evaluated using specialized commercial kits. RESULTS The mean flap survival rate was increased significantly in DAVS and DAS groups than in DVS and control groups. DAVS and DAS groups had higher flap vascularization, MVD, CD34-positive microvessel density, VEGF expression and SOD level compared to DVS and control groups. DAVS and DAS groups also had lower MDA level relative to DVS and control groups. CONCLUSION DAS is more conducive to improving the survival rate of the multiterritory perforator flap compared to DVS, mainly by enhancing angiogenesis and preventing ischemia-reperfusion (I/R) injury.
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Affiliation(s)
- Wei Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenjing Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xinyi Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiaojing Li
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Abstract
Propeller flaps represent an outstanding alternative to conventional pedicled and free flap options in lower extremity reconstruction, offering significant advantages over the latter. An understanding of the perforasome concept, hot and cold perforator locations, and basic flap design enable the surgeon to readily harvest flaps based on any clinically relevant perforator in freestyle fashion. The purpose of this article is to review fundamentals of propeller flap design and harvest in the lower extremity and discuss reconstructive strategies by level of injury.
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Affiliation(s)
- Jordan T Blough
- Division of Plastic Surgery, Baylor Scott & White Health, Scott & White Memorial Hospital, 2401 South 31st Street, Temple, TX 76508, USA
| | - Michel H Saint-Cyr
- Division of Plastic Surgery, Baylor Scott & White Health, 2401 South 31st Street, Temple, TX 76508, USA.
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Shih YJ, Wang YC, Lin CT, Chang SC, Tzeng YS, Dai NT, Chen TM, Wang CH, Chen SG. Clinical Application of the Peroneal Artery Perforator Flap for Reconstruction of Lateral Malleolus Defects. INT J LOW EXTR WOUND 2021; 22:378-384. [PMID: 33949231 DOI: 10.1177/15347346211015828] [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] [Indexed: 11/15/2022]
Abstract
The reconstruction of defects of the lateral malleolus involving the exposed fibular bone or tendon is challenging. This study aimed to evaluate the clinical application of the peroneal artery perforator flap with or without split-thickness skin grafting for soft tissue reconstruction of the bony defect of the lateral malleolus of the ankle joints. Reconstruction using a peroneal artery perforator flap with or without split-thickness skin grafting was performed for 15 patients (10 men, 5 women) between January 2007 and December 2018. The mean age was 53.7 years, and the mean size of the flaps was 40 cm2. The flaps were elevated in the form of a perforator flap, and split-thickness skin grafting was performed over the flaps and adjoining raw areas. The flaps survived in all cases; however, partial necrosis was observed in 3 cases. In cases of small-sized defects of the lateral malleolus of the ankle joints where a flap is required for the exposed bone or tendon, reconstruction using the peroneal artery perforator flap is advantageous, since the morbidity rate of the donor site is low and soft tissue is reconstructed.
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Affiliation(s)
- Yu-Jen Shih
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Yen-Chun Wang
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Chin-Ta Lin
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Shun-Cheng Chang
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Yuan-Sheng Tzeng
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Niann-Tzyy Dai
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Tim-Mo Chen
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Chih-Hsin Wang
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
| | - Shyi-Gen Chen
- Division of Plastic Surgery, Department of Surgery, 63452Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C.)
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Risk factors related to the partial necrosis of the posterior tibial artery perforator-plus fasciocutaneous flap. Eur J Trauma Emerg Surg 2021; 48:1247-1253. [PMID: 33611624 DOI: 10.1007/s00068-021-01616-0] [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] [Received: 11/11/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE AND BACKGROUND The posterior tibial artery perforator-plus fasciocutaneous (PTAPF) flap is commonly used for defects over the distal lower extremity. However, the causes of partial necrosis of the PTAPF flap are unknown. This paper aimed to explore the factors related to the partial necrosis of the PTAPF flap. METHODS A retrospective study was conducted on 59 patients who received the PTAPF flap for soft-tissue defects between September 2007 and September 2017. The clinical outcomes of the flap were evaluated, and the patient and surgical factors related to flap survival were analyzed. RESULTS Of the 59 patients, 9 (15.25%) flaps exhibited partial necrosis. No significant differences were found between the survival and partial necrosis groups regarding gender, age, soft tissue defect site, length and width of the fascia pedicle, length of the skin island, length-width ratio (LWR), and pivot point (P > 0.05). However, the survival group showed significantly less width of the skin island and total length of the flap than the partial necrosis group (P < 0.05). Multiple logistic regression analysis revealed that the width of the skin island was an independent risk factor affecting partial flap necrosis (OR = 4.028; P = 0.041). CONCLUSIONS The PTAPF flap can be effectively used to repair small and medium wounds of the lower and middle leg, ankle and foot. As the width of the skin island exceeds 6 cm, the risk of partial flap necrosis significantly increases.
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Fahim RX, AbdelFattah SR. Peroneal Artery Adipofascial Flaps for Coverage of Distal Leg and Rearfoot. Clin Podiatr Med Surg 2020; 37:681-697. [PMID: 32919598 DOI: 10.1016/j.cpm.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic wounds of the lower extremity can pose several obstacles for the treating physician as well as the patient. Peroneal artery adipofascial flaps have been shown to be a reliable and durable option for reconstruction of these defects for many reasons, including ease of dissection, minimized donor site mobility, reliability of take to underlying surfaces, and cosmetically more pleasing outcome. This article discusses the current literature regarding the use of peroneal artery adipofascial flaps and our surgical technique for harvest, transfer, and postoperative course for this versatile flap.
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Affiliation(s)
- Ramy X Fahim
- Foot and Ankle Surgery, Mercy Health, Youngstown, OH, USA; Northern Ohio Medical Specialties (NOMS) Healthcare, Sandusky, OH, USA.
| | - Sharif R AbdelFattah
- East Liverpool City Hospital, East Liverpool, OH, USA; Sullivan County Community Hospital, 2200 North Section Street, Sullivan, IN 47882, USA
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Chen Z, Zhang C, Ma H, Huang Z, Li J, Lou J, Li B, Tu Q, Gao W. Detrimental Effect of Sitagliptin Induced Autophagy on Multiterritory Perforator Flap Survival. Front Pharmacol 2020; 11:951. [PMID: 32670067 PMCID: PMC7332881 DOI: 10.3389/fphar.2020.00951] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/11/2020] [Indexed: 01/09/2023] Open
Abstract
Multiterritory perforator flap survival is commonly applied in surgical tissue reconstructions and covering of large skin defects. However, multiple risk factors such as ischemia, reperfusion injury, and apoptosis after reconstructive surgeries cause necrosis in distal parts with outcomes ranging from poor aesthetic appearance to reconstructive failure. A few studies have reported that sitagliptin (Sit) promotes angiogenesis and inhibits apoptosis. However, little is known about Sit-induced autophagy especially on the flap model. Therefore, our study investigated the effect of Sit and its induced autophagy on the perforator flap survival. Ninety male Sprague-Dawley rats were randomly separated into control, Sit, and Sit+3-methyladenine group. Results revealed that Sit significantly promoted flap survival by enhancing angiogenesis, reducing oxidative stress, and attenuating apoptosis. In addition, flap survival was further improved after co-administration with 3-methyladenine to inhibit autophagy. Overall, our results established that Sit has positive effects in promoting survival of multiterritory perforator flap. Sit-induced autophagy was detrimental for flap survival and its inhibition may further improve flap survival.
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Affiliation(s)
- Zhengtai Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Chenxi Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Haiwei Ma
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Zihuai Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Jiafeng Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Junshen Lou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Baolong Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
- Department of Second Clinical Medical, The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Qi Tu
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of First Clinical Medical, The First Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Weiyang Gao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Orthopaedics, Zhejiang Provincial Key Laboratory of Orthpaedics, Wenzhou, China
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Soteropulos CE, Shulzhenko NO, Nayar HS, Poore SO. The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review. J Reconstr Microsurg 2020; 36:634-644. [DOI: 10.1055/s-0040-1713598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls of microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined the impact of perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and impact of pedicle skeletonization on perforator-based fasciocutaneous flaps of the lower extremity.
Methods PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were reviewed for literature examining perforator-based fasciocutaneous flaps from knee to ankle, from January 2000 through November 2018. The Preferred Reporting Items for Systematic Reviews-Individual Participant Data (PRISMA-IPD) structure was used.
Results Thirty-six articles were included for quantitative analysis. Of 586 flaps, 365 were skeletonized (60.1%) with 58 major (9.9%) and 19 minor complications (3.2%). With skeletonization, overall reoperative rate was higher (odds ratio [OR]: 9.71, p = 0.004), specifically in propeller (OR: 12.50, p = 0.004) and rotational flaps (OR: 18.87, p = 0.004). The complication rate of rotational flaps also increased (OR: 2.60, p = 0.04). Notably, skeletonization reduced complications in flaps rotated 90 degrees or more (OR: 0.21, p = 0.02). Reoperative rate of distal third defects (OR: 14.08, p = 0.02), flaps over 48 cm2 (OR: 33.33, p = 0.01), and length to width ratios over 1.75 (OR: 7.52, p = 0.03) was increased with skeletonization. Skeletonization increased complications in traumatic defects (OR: 2.87, p = 0.04) and reduced complications in malignant defects (OR: 0.10, p = 0.01).
Conclusion Pedicled, perforator-based flaps can provide a reliable locoregional alternative to free tissue transfer for lower extremity defects. Though skeletonization increased the overall reoperative rate, the complication rate for flaps with 90 degrees or more of rotation was significantly reduced. This suggests skeletonization should be considered when large rotational movements are anticipated to reduce complications that can arise from pedicle compression and venous congestion.
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Affiliation(s)
- Carol E. Soteropulos
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nikita O. Shulzhenko
- Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Harry S. Nayar
- Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samuel O. Poore
- Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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The Microvascular Peroneal Artery Perforator Flap as a "Lifeboat" for Pedicled Flaps. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2396. [PMID: 31942377 PMCID: PMC6908404 DOI: 10.1097/gox.0000000000002396] [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: 04/05/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Abstract
Pedicled perforator flaps have expanded reconstructive options in extremity reconstruction. Despite preoperative mapping, intraoperative findings may require microvascular tissue transfer when no adequate perforators can be found. The free peroneal artery perforator flap may serve as a reliable back-up plan in small defects.
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Luan Z, Liu B, Jiang H, Gao F, Yang B. Reverse first dorsal metacarpal artery flap repair of a right thumb epidermis granuloma: A case study. Oncol Lett 2019; 18:2384-2387. [PMID: 31402941 PMCID: PMC6676728 DOI: 10.3892/ol.2019.10583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/07/2019] [Indexed: 11/16/2022] Open
Abstract
One case of epidermal granuloma of the right thumb was diagnosed by color Doppler ultrasonography and pathologic examination. Epidermal granuloma resection and reverse island skin flap transplantation were performed to determine the therapeutic effect of a reverse first dorsal metacarpal artery flap repair of an epidermal granuloma of the right thumb. After effective intravenous combined general anesthesia, the skin in the surgical field was disinfected and sterile drapes were placed. An oblique incision was made over the underlying epidermis granuloma. The right palm of the reverse first dorsal metacarpal artery flap was chosen. The pedicle was carefully protected, and the flap was transplanted to the defective skin area. The incision was sutured after hemostasis. A palpable mass with the dimension of the right thumb of the patient was measured by color Doppler ultrasonography and physical examination pre-operatively. The palpable mass was oval in shape and protruded from the skin surface. The palpable mass had an unclear boundary with the surrounding skin and therefore the skin should be removed. If the tendon is exposed after the resection, complications may occur after operation, such as skin necrosis and tendon exposure. Intra-operatively, the mass was 1.5×1.0 cm in size and multi-cystic. The boundary between the palpable mass and the surrounding skin could not be discerned. The skin area (1.5×1.0 cm in size) was completely invaded by the palpable mass, which was closely adhered to the surrounding tissue. The palpable mass was carefully dissected with appropriate protection to the finger nerves and arteries. The palpable mass and affected skin were completely removed, leaving a defect area of ~1.5 ×1.0 cm without skin. The reverse first dorsal metacarpal artery flap was used to repair the defect area. The repaired flap had a good blood supply and peripheral circulation. The operation was successful, and the anesthesia effect was satisfactory. Treatment of a thumb epidermis granuloma with reverse first dorsal metacarpal artery flap was shown to be a feasible strategy with a broad clinical application.
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Affiliation(s)
- Zhiyong Luan
- The Second Department of Surgery, Changchun Children's Hospital, Changchun, Jilin 130000, P.R. China
| | - Biao Liu
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hongbo Jiang
- The Second Department of Surgery, Changchun Children's Hospital, Changchun, Jilin 130000, P.R. China
| | - Fengqi Gao
- The Second Department of Surgery, Changchun Children's Hospital, Changchun, Jilin 130000, P.R. China
| | - Baogang Yang
- The Second Department of Surgery, Changchun Children's Hospital, Changchun, Jilin 130000, P.R. China
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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Ziquan W, Delu Z, Jiangling Y, Yangyang B, Yuntao G, Zhulong M, Jian F, Lei P. Research Progress on Diagnosis and Treatment of Chronic Osteomyelitis. ACTA ACUST UNITED AC 2019; 34:211-220. [DOI: 10.24920/003493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Masquelet AC, Gaillard J, Cambon-Binder A, Mauprivez R. [The fascio-cutaneous fibular island flap]. ANN CHIR PLAST ESTH 2018; 63:294-298. [PMID: 29735332 DOI: 10.1016/j.anplas.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 02/19/2018] [Indexed: 01/09/2023]
Abstract
The perforators of the fibular artery provide a well vascularised supra fascial network which allows to raise a proximally or a distally based island fascio cutaneous flap with an adipo-fascial pedicle. We present a short series of five cases of this flap for coverage of soft tissue defects involving the region of the knee, the distal third of the leg and the lateral aspect of the heel. All flaps healed entirely without venous congestion. The advantages of the fascio cutaneous fibular island flap are the supine operative position, the preservation of the sural nerve and the lesser saphenous vein and a pivot point which can be located at the middle third of the leg. According to our experience, the fascio cutaneous fibular island flap is especially indicated for repairing defects of the distal leg.
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Affiliation(s)
- A-C Masquelet
- Service de chirurgie orthopédique, traumatologique et réparatrice, université Paris-VI, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France.
| | - J Gaillard
- Service de chirurgie orthopédique, traumatologique et réparatrice, université Paris-VI, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - A Cambon-Binder
- Service de chirurgie orthopédique, traumatologique et réparatrice, université Paris-VI, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
| | - R Mauprivez
- Service de chirurgie orthopédique, traumatologique et réparatrice, université Paris-VI, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France
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