Microsurgical reconstruction of extensive lower extremity defects with the conjoined parascapular and latissimus dorsi free flap

Patients scheduled for microsurgical reconstruction of the lower leg often receive preoperative assessment of recipient vessels using angiography. However, no clear standard is available for evaluating angiographic results to predict free-flap survival outcomes. We developed angiographic criteria for predicting surgical outcome in patients with lower-extremity peripheral arterial disease based on abnormality of the anterior tibial and posterior tibial arteries. We applied the criteria to a small number of patients scheduled for microsurgical reconstruction of the lower leg. Angiographies with arterial abnormalities were classified into 3 groups: favorable free-flap survival, compromised free-flap survival, and postsurgical pedal ischemia. The study enrolled 50 patients between 2005 and 2013. In 42% of patients, arterial abnormalities were observed by angiography. Age >65 years was the strongest risk factor for development of lower-leg arterial abnormality ( P < .001). The anterior tibial and peroneal arteries were significantly more stenotic than other vessels. In the favorable free-flap survival and compromised free-flap survival groups, free-flap transfers were attempted in 7 patients but intraoperatively abandoned in 2 patients, with postoperative failure in 1 patient. In the postsurgical pedal ischemia group, free-flap transfers were attempted in 10 patients but intraoperatively abandoned in 6 patients, with postoperative failure in 3.

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Cross-leg latissimus dorsi free flap with chimeric serratus anterior bridge for lower extremity trauma: Case report and reconstructive algorithm

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.08.012 ◽

2019 ◽

Vol 10 (5) ◽

pp. 867-872

Author(s):

Jocelyn Lu ◽

Vincent Chavanon ◽

Ilana Margulies ◽

Alice S. Yao

Keyword(s):

Case Report ◽

Lower Extremity ◽

Free Flap ◽

Latissimus Dorsi ◽

Serratus Anterior ◽

Lower Extremity Trauma ◽

Extremity Trauma ◽

Trauma Case ◽

Reconstructive Algorithm

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The Muscle-Sparing Descending Branch Latissimus Dorsi Free Flap for Lower Extremity Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000007302 ◽

2020 ◽

Vol 146 (5) ◽

pp. 693e-694e

Author(s):

Shi-Ming Feng ◽

Ai-Guo Wang

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Latissimus Dorsi ◽

Lower Extremity Reconstruction ◽

Extremity Reconstruction ◽

Muscle Sparing

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Use of the SurroSense Rx System for Sensory Substitution of the Insensate Plantar Foot Resurfaced With Latissimus Dorsi Muscle Free Flap and Skin Graft

Plastic Surgery Case Studies ◽

10.1177/2513826x17716456 ◽

2017 ◽

Vol 3 ◽

pp. 2513826X1771645 ◽

Cited By ~ 1

Author(s):

Emily Bray ◽

Breanne Everett ◽

Alexa Mouawad ◽

A. Robertson Harrop ◽

Carmen Brauer

Keyword(s):

Lower Extremity ◽

Skin Graft ◽

Free Flap ◽

Latissimus Dorsi ◽

Traumatic Injury ◽

Critical Factor ◽

Sensory Substitution ◽

Degloving Injury ◽

Protective Sensation ◽

Loss Of Protective Sensation

Degloving injuries of the foot pose an important challenge to the reconstructive surgeon. Key features of reconstruction include sensibility, stability, and durability. Preservation of plantar sensibility is considered to be a critical factor in the evaluation of lower extremity trauma, with its absence once being considered an indication for amputation. However, recent studies show that outcomes following limb preservation are not as adversely affected by a lack of plantar sensation than was once thought. With the increasing practice pattern of attempting limb salvage in the face of impaired plantar sensation, methods and devices designed to provide patients with maximal protection for loss of protective sensation (LOPS) in the affected limb are critical. The authors present the innovative use of the SurroSense Rx smart insole system (Orpyx Medical Technologies Inc, Calgary, Canada) in the management of LOPS in a patient with a degloving injury of the foot that was reconstructed with a latissimus dorsi free flap and skin graft. To the authors’ knowledge, this is the first reported case of use of such a system following a traumatic injury to the lower extremity.

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