Advanced Plastic Surgery Techniques for Soft Tissue Coverage of the Diabetic Foot

2007 ◽  
Vol 24 (3) ◽  
pp. 547-568 ◽  
Author(s):  
Thomas Zgonis ◽  
John J. Stapleton ◽  
Thomas S. Roukis
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Diabetic Foot ◽  
Soft Tissue Coverage

The Role of Plastic Surgery for Soft Tissue Coverage of the Diabetic Foot and Ankle

2014 ◽  
Vol 31 (1) ◽  
pp. 127-150 ◽  
Author(s):  
Peter A. Blume ◽  
Ryan Donegan ◽  
Brian M. Schmidt
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Diabetic Foot ◽  
Soft Tissue Coverage ◽  
Foot And Ankle

Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

Modalities of Soft-Tissue Coverage in Diabetic Foot Ulcers

2015 ◽  
Vol 28 (4) ◽  
pp. 157-162 ◽  
Author(s):  
Sohaib Akhtar ◽  
Imran Ahmad ◽  
A.H. Khan ◽  
M. Fahud Khurram
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Foot Ulcers ◽  
Soft Tissue Coverage ◽  
Diabetic Foot Ulcers

scholarly journals Soft tissue coverage types for complex limb trauma in children

2015 ◽  
Vol 10 (4) ◽  
pp. 348-354
Author(s):  
Ileana-Carmen MATLAC ◽  
◽  
Dan Mircea ENESCU ◽  
◽  
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Upper Limb ◽  
Soft Tissue Coverage ◽  
Local Flaps ◽  
Affected Area ◽  
Children's Hospital ◽  
Limb Trauma ◽  
Minimum Age

Objective. The analysis of the soft tissue coverage types employed in complex limb trauma in children towards a potential subsequent optimization of their management. Materials and methods. Data regarding the children admitted to the Burns and Plastic Surgery Clinic of ‘Grigore Alexandrescu’ children’s hospital, between 2005 and 2013 with complex limb trauma requiring soft tissue coverage was obtained from the surgical protocols. Information was gathered regarding patients’ sex and age, the type of incident, the mode of occurence, the region in need of coverage, the number and type of surgical procedures, as well as regarding the type of coverage employed. Results. A number of 80 children required soft tissue coverage in complex limb trauma. Boys accounted for approximately two thirds of all cases. The pacients had a minimum age of 1 year and a maximum one of 16 years. There were approximately 50% more trauma of this type affecting the upper limb than the lower one. The fingers required coverage in the majority of cases (77.5%). In the majority of cases at this level (77%) split-level thickness grafts and local flaps were applied. Conclusions. The majority of the complex pediatric soft tissue limb coverage cases were boys. Fingers were the predominantly affected area and most often the usage of split-level thickness grafts or of local flaps was required. The accidents were predominantly home related. The cases had an uncomplicated evolution, the coverage solutions employed being successful in over 90% of the situations.

Modification of the abductor digiti minimi muscle flap for soft tissue coverage of the diabetic foot

2020 ◽  
Vol 29 (Sup7) ◽  
pp. S32-S36
Author(s):  
Crystal L Ramanujam ◽  
Alan C Suto ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Diabetic Foot ◽  
Donor Site ◽  
Muscle Flap ◽  
Surgical Reconstruction ◽  
Soft Tissue Coverage ◽  
Skin Island ◽  
Abductor Digiti Minimi ◽  
Abductor Digiti Minimi Muscle

The local intrinsic abductor digiti minimi muscle flap is ideal for lateral, plantar lateral traumatic or diabetic foot wounds following adequate surgical debridement to eradicate any soft tissue and/or osseous infection. Although the indications and surgical technique have been well-described in the literature, the authors present a unique modification of tunnelling the harvested muscle flap directly from the donor site to the plantar recipient foot wound by maintaining the intact overlying skin island at the surface of the fifth metatarsal base. This modification allows preservation of the patient's skin integrity in this area, thereby minimising potential morbidity at the major pedicle site. After the harvested muscle is tunnelled through the intact skin island, an adjacent local random flap mobilisation, autogenous or allogeneic skin graft can then be used for coverage over the muscle inset if primary wound closure is not feasible. Simultaneous soft tissue or osseous surgical procedures and/or surgical offloading with external fixation at the time of index surgery may be necessary to achieve optimal outcomes. The authors present a modified surgical technique for the abductor digiti minimi muscle flap that can be performed in the surgical reconstruction of a soft tissue wound in patients with diabetic Charcot neuroarthropathy.

Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
GiJun Lee ◽  
BumSik Kim ◽  
Neunghan Jeon ◽  
JungSoo Yoon ◽  
Ki Yong Hong ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Upper Extremity ◽  
Reverse Flow ◽  
Donor Site ◽  
Congenital Defects ◽  
Soft Tissue Coverage ◽  
Posterior Interosseous Artery ◽  
Arterial Inflow ◽  
Pedicle Length ◽  
Interosseous Artery

Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

FREE FLAPS FOR SOFT TISSUE COVERAGE IN THE HAND AND FINGERS

Hand Clinics ◽  
1999 ◽  
Vol 15 (4) ◽  
pp. 541-554 ◽  
Author(s):  
Hung-Chi Chen ◽  
Mark T. Buchman ◽  
Fu-Chan Wei
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Soft Tissue Coverage

Workhorse Flaps for Soft Tissue Coverage in the Hand

2012 ◽  
Vol 22 (3) ◽  
pp. 119-130
Author(s):  
Paul Tran ◽  
Crystal Kavanagh ◽  
Steven L. Moran
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Coverage

scholarly journals 592 Surgical Management of Open Tibia Fractures at A Major Trauma Centre: A Review of Cases Over A One-Year Period

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Khajuria
Keyword(s):  
Soft Tissue ◽  
Surgical Management ◽  
Open Fracture ◽  
Major Trauma ◽  
Trauma Centre ◽  
Soft Tissue Coverage ◽  
Internal Stabilization ◽  
Major Trauma Centre ◽  
Tibia Fractures ◽  
One Year

Abstract Introduction The BOAST/BAPRAS updated the open fracture guidelines in December 2017 to replace BOAST 4 Open fracture guidelines; the changes gave clearer recommendations for timing of surgery and recommendations for reducing infection rates. Method Our work retrospectively evaluates the surgical management of open tibia fractures at a Major Trauma Centre (MTC), over a one-year period in light of key standards (13,14 and 15 of the standards for open fractures). Results The vast majority of cases (93%) had definitive internal stabilization only when immediate soft tissue coverage was achievable. 90% of cases were not managed as ‘clean cases’ following the initial debridement. 50% of cases underwent definitive closure within 72 hours. The reasons for definitive closure beyond 72hours were: patients medically unwell (20%), multiple wound debridement’s (33%) and no medical or surgical reason was clearly stated (47%). Conclusions The implementation of a ‘clean surgery’ protocol following surgical debridement is essential in diminishing risk of recontamination and infection. Hence, this must be the gold standard and should be clearly documented in operation notes. The extent of availability of a joint Orthoplastic theatre list provides a key limiting step in definitive bony fixation and soft tissue coverage of open tibia fractures.

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