Distally-based random fasciocutaneous flaps for multi-staged reconstruction of defects in the lower third of the leg, ankle and heel

Abstract Introduction and Methods Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot’s degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author’s procedure was 96.4% (p = 0.045). Conclusion Author’s protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.

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Distally Based Sural Fasciocutaneous Flaps for Reconstructing Soft Tissue Defects Proximal and Distal to the Tarsometatarsal Joints: A Comparative Analysis

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211002333 ◽

2021 ◽

pp. 153473462110023

Author(s):

Zhaobiao Luo ◽

Jiangdong Ni ◽

Guohua Lv ◽

Jianwei Wei ◽

Lihong Liu ◽

...

Keyword(s):

Comparative Analysis ◽

Soft Tissue ◽

Clinical Outcomes ◽

Salvage Treatment ◽

Soft Tissue Defects ◽

Fasciocutaneous Flaps ◽

Partial Necrosis ◽

Number Of Patients ◽

Distally Based ◽

Tissue Defects

Distally based sural fasciocutaneous (DBSF) flaps are widely used for reconstructing soft tissue defects of the foot. The purpose of this paper was to compare the clinical efficacy of the use of flaps to repair defects in areas proximal and distal to the level of the tarsometatarsal joints in a relatively large number of patients and to analyze the effects of factors on the risk of developing partial necrosis of the flaps. Between April 2001 and December 2019, a total of 355 DBSF flaps were utilized to cover soft tissue defects in the foot. According to the furthest location of the defects reconstructed with the flaps, the flaps were divided into the proximal foot group (n = 260) and the distal foot group (n = 95). The partial necrosis rates, their influencing factors, and the clinical outcomes of the procedure were compared between the two groups. In the proximal foot group, the partial necrosis rate (6.2%, 16 of 260) was significantly lower than that in the distal foot group (14.7%, 14 of 95) ( P < .05). The proportion of successful coverage of the defects using the flaps alone or in combination with a simple salvage treatment was comparable between the groups ( P > .05). The ratio of unfavorable conditions in the distal foot group was higher than that in the proximal foot group ( P < .05). DBSF flaps can be effectively utilized to repair defects in the proximal and distal areas of the foot. The use of a DBSF flap to repair defects in the proximal areas of the foot is superior to the use of DBSF flaps for repairing defects in the distal areas of the foot in terms of reliable survival of the flap.

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CAN SUPERFICIAL VEINS REVERSE FLOW THROUGH VALVES IN DISTALLY BASED FASCIOCUTANEOUS FLAPS?

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199105000-00038 ◽

1991 ◽

Vol 87 (5) ◽

pp. 995-996 ◽

Cited By ~ 15

Author(s):

Slu-Min Chang ◽

Zhong-Wei Chen

Keyword(s):

Reverse Flow ◽

Fasciocutaneous Flaps ◽

Flow Through ◽

Distally Based

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Anatomic study of septocutaneous system of the human fetuses’ lower leg: Posterior tibial artery

Vojnosanitetski pregled ◽

10.2298/vsp170525166s ◽

2019 ◽

Vol 76 (7) ◽

pp. 728-732

Author(s):

Goran Stevanovic ◽

Marija Dakovic-Bjelakovic ◽

Boban Djordjevic ◽

Jadranka Paravina ◽

Ivan Golubovic ◽

...

Keyword(s):

Blood Vessels ◽

Vascular System ◽

Vascular Anatomy ◽

Lower Leg ◽

Posterior Tibial Artery ◽

Fasciocutaneous Flaps ◽

Posterior Tibial ◽

Tibial Artery ◽

Distally Based ◽

Level Of Understanding

Background/Aim. Lower-leg septocutaneous system of perforating blood vessels represents the vascular basis of fasciocutaneous flaps. Additionally, it is of a particular importance when designing distally based fasciocutaneous flaps which represent the ?workhorse? in the reconstruction of the distal third of the lower leg and foot. The aim of this study was to analyse the vascular anatomy of posterior tibial artery and its septocutaneous (fasciocutaneous) perforating arterial vessels. Methods. The dissection was conducted on 20 fetuses of both sexes and of gestational age from 20 to 28 weeks. Cluster analysis was applied to the data on vascular anatomy of posterior tibial artery and its septocutaneous performating arterial vessels. Results. A total of 212 perforating arterial vessels was identified. The average number of perforating arterial vessels was 5.32 (ranging from 4 to 7). It was identified that septocutaneous perforating blood vessels are more likely to be found at certain levels (?safe levels of finding perforators?). These are: second, third, fifth and sixth tenth (measured as a distance from intermalleolar line to popliteal crease). Conclusion. The presence of septocutaneous system of perforating blood vessels and reliability of their localization even in the fetal period allows application of these findings in the lower leg reconstructions in children of early age. It also contributes to the greater level of understanding of anatomy of the lower-leg vascular system. Finally, it provides a basis for understanding the development of this system as it is now possible to compare results obtained on fetuses with those obtained on adults.

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