Treatment of extensive bone and soft tissue defects of the lower limb by traction and free-flap transfer

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

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Reconstruction of the Lower Leg With Percutaneous Aponeurotomy and Lipofilling: A Case Report

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734619864192 ◽

2019 ◽

Vol 18 (3) ◽

pp. 336-338

Author(s):

Yooseok Ha ◽

Hee Sang Yang ◽

Seung Han Song ◽

Sang-Ha Oh

Keyword(s):

Soft Tissue ◽

Lower Leg ◽

Tissue Loss ◽

Local Flaps ◽

Soft Tissue Defects ◽

Established Method ◽

Flap Transfer ◽

Free Flap Transfer ◽

Soft Tissue Loss ◽

Tissue Defects

Soft tissue loss in the lower leg presents a challenge for reconstructive surgeons. When a defect is large, free flap transfer provides a well-established method, but local flaps are more convenient for small to moderately sized soft tissue defects. When a defect is very small, even local flaps are too invasive, leave additional scar, and cause bulky flaps. We present our case aiming to underline the usefulness of percutaneous aponeurotomy and lipofilling in a small lower leg defect with several advantages.

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Free Flap Transfer to Preserve Main Arterial Flow in Early Reconstruction of Open Fracture in the Lower Extremity

Plastic Surgery International ◽

10.1155/2015/213892 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Mitsuru Nemoto ◽

Shinsuke Ishikawa ◽

Natsuko Kounoike ◽

Takayuki Sugimoto ◽

Akira Takeda

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Free Flap ◽

Open Fracture ◽

Posterior Tibial Artery ◽

Flap Transfer ◽

Posterior Tibial ◽

Free Flap Transfer ◽

Flow Through ◽

Tissue Defects

The selection of recipient vessels is crucial when reconstructing traumatized lower extremities using a free flap. When the dorsalis pedis artery and/or posterior tibial artery cannot be palpated, we utilize computed tomography angiography to verify the site of vascular injury prior to performing free flap transfer. For vascular anastomosis, we fundamentally perform end-to-side anastomosis or flow-through anastomosis to preserve the main arterial flow. In addition, in open fracture of the lower extremity, we utilize the anterolateral thigh flap for moderate soft tissue defects and the latissimus dorsi musculocutaneous flap for extensive soft tissue defects. The free flaps used in these two techniques are long and include a large-caliber pedicle, and reconstruction can be performed with either the anterior or posterior tibial artery. The preparation of recipient vessels is easier during the acute phase early after injury, when there is no influence of scarring. A free flap allows flow-through anastomosis and is thus optimal for open fracture of the lower extremity that requires simultaneous reconstruction of main vessel injury and soft tissue defect from the middle to distal thirds of the lower extremity.

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Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

Bangladesh Journal of Plastic Surgery ◽

10.3329/bdjps.v3i2.18242 ◽

2014 ◽

Vol 3 (2) ◽

pp. 33-37

Author(s):

Debashis Biswas ◽

Md Abul Kalam ◽

Tanveer Ahmed ◽

Md Rabiul Karim Khan

Keyword(s):

Soft Tissue ◽

Free Flap ◽

Free Flaps ◽

Soft Tissue Defect ◽

Soft Tissue Defects ◽

Tissue Defect ◽

Radial Forearm ◽

After Cancer ◽

Microvascular Free Flap ◽

Tissue Defects

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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Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418805698 ◽

2018 ◽

Vol 43 (10) ◽

pp. 1019-1029 ◽

Cited By ~ 17

Author(s):

David Elliot ◽

Roberto Adani ◽

Sang Hyun Woo ◽

Jin Bo Tang

Keyword(s):

Soft Tissue ◽

Skin Graft ◽

Soft Tissue Defects ◽

Flap Transfer ◽

Less Invasive ◽

Defect Site ◽

Venous Flaps ◽

Occlusive Dressings ◽

Recent Developments ◽

Tissue Defects

We review recent developments in using occlusive dressings, dermal templates, and venous flaps for less invasive approaches to treat soft tissue defects of the forearm and fingers. Occlusive dressings can be used for thumb tip or fingertip trauma with soft tissue defects of small or moderate sizes. They permit skin regeneration without use of skin graft or a flap transfer. This is currently a popular way to treat tip soft tissue defects in European countries. Extensive soft tissue defects in the thumb, fingers, hand and forearm require flap transfers traditionally, but in recent years, surgeons use dermal templates to cover the defect site to allow regeneration of subcutaneous tissues, over which a skin graft is used in lieu of a flap. Transfer of a venous flap is currently a reliable procedure and is less invasive compared with conventional flaps, which usually damage a named artery in the donor. We advocate that less invasive methods should be considered for soft tissue defects in the hand and forearm.

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