The ulnar forearm free flap for the reconstruction of soft tissue defects in the head and neck area: Free flap outcome and donor site outcome

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

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Use of Serial Flap Transfer Technique in En Bloc Reconstruction of Extensive Soft Tissue Defects in the Head and Neck

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000007682 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Mengqing Zang ◽

Shan Zhu ◽

Bo Chen ◽

Shanshan Li ◽

Tinglu Han ◽

...

Keyword(s):

Soft Tissue ◽

Head And Neck ◽

Soft Tissue Defects ◽

En Bloc ◽

Flap Transfer ◽

Tissue Defects

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A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

Foot & Ankle Specialist ◽

10.1177/1938640018816378 ◽

2018 ◽

Vol 12 (5) ◽

pp. 432-438 ◽

Cited By ~ 2

Author(s):

Chahine Assi ◽

Camille Samaha ◽

Moussa Chamoun Moussa ◽

Tony Hayek ◽

Kaissar Yammine

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Low Frequency ◽

Group Versus ◽

Healing Time ◽

Diabetic Patients ◽

Trauma Patients ◽

Soft Tissue Defects ◽

Cutaneous Flap ◽

Tissue Defects

Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compared the reliability of the RSFCF in treating such defects among both populations. Methods. This is a retrospective series with a prospective data collection of 24 patients (11 with type 2 diabetes and 13 in trauma settings) treated with an ipsilateral RSFCF for soft tissue defects of the distal leg and the rear foot. Healing events and complications were recorded and compared for both groups. The mean follow-up was 32 months. Results. Diabetic group versus trauma group showed the following results; mean flap healing time of 24 versus 22 days, donor site healing time of 14 versus 16 days, 1 total flap necrosis in both groups, 3 versus 2 cases of skin edge necrosis, 2 cases of temporary venous congestion in both groups, and 8 versus 10 cases of transient hypoesthesia of the lateral border of the foot. No infection was encountered in both groups and no recurrence of infection in the primary infected diabetic patients. Conclusions. We found the RSFCF to be useful, reproducible, and reliable in treating soft tissue defects with a very low frequency of serious complications. Diabetic patients were found to have similar outcomes when compared with trauma patients. Therefore, diabetes might not be a major factor of flap failure. Levels of Evidence: Level III: Therapeutic

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Flaps optimisation selection in reconstruction of head and neck soft tissue defects

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2017.02.596 ◽

2017 ◽

Vol 46 ◽

pp. 174

Author(s):

M.T. Aladimi ◽

L.J. Li ◽

P. Han ◽

C.J. Li ◽

H.H. Helal

Keyword(s):

Soft Tissue ◽

Head And Neck ◽

Soft Tissue Defects ◽

Tissue Defects

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Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

Journal of International Medical Research ◽

10.1177/0300060516687229 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1074-1089 ◽

Cited By ~ 10

Author(s):

Lifeng Shen ◽

Yiyang Liu ◽

Chun Zhang ◽

Qiaofeng Guo ◽

Wenhua Huang ◽

...

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Lower Leg ◽

Soft Tissue Defect ◽

Venous Congestion ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Propeller Flap ◽

Perforator Vessel ◽

Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

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Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

Foot & Ankle International ◽

10.1177/107110070502600302 ◽

2005 ◽

Vol 26 (3) ◽

pp. 191-197 ◽

Cited By ~ 15

Author(s):

Frederick J. Duffy ◽

James W. Brodsky ◽

Christian T. Royer

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Donor Site Morbidity ◽

Tissue Loss ◽

Soft Tissue Reconstruction ◽

Foot And Ankle ◽

Soft Tissue Defects ◽

Perforator Flaps ◽

Microsurgical Reconstruction ◽

Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

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Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

Indian Journal of Plastic Surgery ◽

10.4103/ijps.ijps_19_17 ◽

2018 ◽

Vol 51 (02) ◽

pp. 216-221 ◽

Cited By ~ 4

Author(s):

Deepak Nanda ◽

Shamendra Anand Sahu ◽

Durga Karki ◽

Sanjay Kumar ◽

Amrita Mandal

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Donor Site ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Tibial Artery ◽

Split Skin ◽

Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

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