Comparing Outcomes for Fasciocutaneous versus Muscle Flaps in Foot and Ankle Free Flap Reconstruction

2019 ◽  
Vol 35 (09) ◽  
pp. 646-651 ◽  
Author(s):  
Z-Hye Lee ◽  
Salma A. Abdou ◽  
David A. Daar ◽  
Lavinia Anzai ◽  
John T. Stranix ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Free Flaps ◽  
Wound Complications ◽  
Foot And Ankle ◽  
Bearing Surface ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Flap Failure ◽  
Wound Breakdown ◽  
Increased Risk

Background The distal lower extremity poses unique reconstructive challenges due to its requirements for durability of the load-bearing plantar surface and for thin, pliable contour in the dorsal foot and ankle region. This study compares outcomes between muscle and fasciocutaneous flaps in patients with foot and ankle defects. Methods A retrospective review of soft tissue free flaps used for traumatic foot and ankle defects was performed. Outcomes included takebacks, partial flap failure, total flap failure, and wound complications. Results A total of 165 cases met inclusion criteria, with muscle flaps (n = 110) comprising the majority. Defects involving the non–weight-bearing surface were more common (n = 86) than those of the weight-bearing surface (n = 79). Complications occurred in 56 flaps (33.9%), including 11 partial losses (6.7%) and 6 complete losses (3.6%). There were no differences in take backs, partial flap failure, or total flap failure between muscle and fasciocutaneous flaps; however, fasciocutaneous flaps had significantly fewer wound complications compared with muscle flaps (7.3% vs. 19.1%, p = 0.046). On multivariable regression analysis, defects of the weight-bearing surface had significantly increased risk of wound breakdown compared with those in the non–weight-bearing surface (odds ratio: 5.05, p = 0.004). Conclusion Compared with fasciocutaneous flaps, muscle flaps demonstrated higher rates of wound complications. While the flap selection in foot and ankle reconstruction depends on the nature of the defect, our findings support the use of fasciocutaneous over muscle flaps in this region.

Free Flap Reconstruction of Traumatic Pediatric Foot and Ankle Defects: An Analysis of Clinical and Functional Outcomes

2021 ◽  
Author(s):  
Rajiv P. Parikh ◽  
Austin Ha ◽  
Thomas Tung
Keyword(s):  
Limb Salvage ◽  
Functional Outcomes ◽  
Free Flaps ◽  
Ankle Injuries ◽  
Foot And Ankle ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Microsurgical Reconstruction ◽  
Pediatric Foot

Abstract Background Traumatic lower extremity injuries involving the foot and ankle can have devastating consequences and represent a complex reconstructive challenge. To date, there are limited reports on microsurgical reconstruction for foot and ankle defects in children. This study aims to evaluate clinical and functional outcomes of free flaps for pediatric foot and ankle injuries. Methods This is a retrospective review of patients undergoing free flaps for traumatic foot and ankle defects at a pediatric trauma center between 2000 and 2015. Patients with less than 5-year follow-up were excluded. Demographics, clinical characteristics, and postoperative outcomes were evaluated. Results Thirty patients undergoing 30 flaps were analyzed. The mean age was 11.9 years (range: 2 to 17 years). Muscle flaps (n = 21, 70%) were more common than fasciocutaneous flaps (n = 9, 30%). Limb salvage with functional ambulation was achieved in 96.7% of patients (n = 29). The complication rate was 33.3% (n = 10), with wound breakdown (n = 6, 20.0%) as most common feature. There were no significant differences in limb salvage, total or partial flap loss, fracture union, and donor-site complications based on flap type. Fasciocutaneous flaps were more likely to require revision procedures for contour compared with muscle flaps (55.6 vs. 9.5%, p = 0.013). Mean follow-up was 8.5 years. Conclusion Microsurgical reconstruction of pediatric foot and ankle defects results in high rates of limb salvage. A defect- and patient-centered approach to reconstruction, emphasizing durable coverage and contour, is critical to facilitating ambulation and ensuring favorable long-term functional outcomes.

Reconstruction of the Weight-Bearing Surface of the Foot with Nonneurosensory Free Flaps

2003 ◽  
Vol 111 (7) ◽  
pp. 2230-2236 ◽  
Author(s):  
Ahmet S??nmez ◽  
Mehmet Bayrami??li ◽  
Burcu S??nmez ◽  
Ayhan Numano??lu
Keyword(s):  
Weight Bearing ◽  
Free Flaps ◽  
Bearing Surface

Single-Stage Bipedicle Local Tissue Transfer and Skin Graft for Achilles Tendon Surgery Wound Complications

2016 ◽  
Vol 10 (1) ◽  
pp. 46-50 ◽  
Author(s):  
Travis J. Dekker ◽  
Yash Avashia ◽  
Suhail K. Mithani ◽  
Andrew P. Matson ◽  
Alexander J. Lampley ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Skin Graft ◽  
Fasciocutaneous Flap ◽  
Single Stage ◽  
Venous Stasis ◽  
Wound Complications ◽  
Foot And Ankle ◽  
Local Tissue ◽  
Tissue Transfer ◽  
Wound Breakdown

Introduction. Achilles tendon and posterior heel wound complications are difficult to treat. These typically require soft tissue coverage via microvascular free tissue transfer at a tertiary referral center. Here, we describe coverage of a series of posterior heel and Achilles wounds via simple, local tissue transfer, called a bipedicle fasciocutaneous flap. This flap can be performed by an orthopaedic foot and ankle surgeon, without resources of tertiary/specialized care or microvascular support. Methods. Three patients with separate pathologies were treated with a single-stage bipedicle fasciocutaneous local tissue transfer. Case 1 was a patient with insertional wound breakdown after Achilles debridement and repair to the calcaneus. Case 2 was a heel venous stasis ulcer with calcaneal exposure in a diabetic patient with vasculopathy. Case 3 was a patient with wound breakdown following midsubstance Achilles tendon repair. All three cases were treated with a single-stage bipedicle local tissue transfer for posterior ankle and heel wound complications. Results. All 3 patients demonstrated complete healing of the posterior defect, lateral ankle skin graft recipient site, and the skin graft donor site after surgery. Case 3 had a subsequent recurrent ulceration after initial healing. This was superficial and healed with local wound care. All patients regained full preoperative range of motion and were able to ambulate independently without modified footwear. Conclusions. The bipedicled fasciocutaneous flap described here offers a predictable single stage procedure that can be accomplished by an orthopaedic foot and ankle surgeon without resources of a tertiary care center for posterior foot and ankle defects. This flap can be performed with short operative times and can be customized to facilitate defect coverage. The flap is durable to withstand local tissue stresses required for early ambulation. Despite its reliability, patients require careful follow-up to manage underlying comorbid conditions that may complicate wound healing. Levels of Evidence: Level IV: Case series

scholarly journals Bilateral Breast Reconstruction with Abdominal Free Flaps: A Single Centre, Single Surgeon Retrospective Review of 55 Consecutive Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Peter McAllister ◽  
Isabel Teo ◽  
Kuen Chin ◽  
Boikanyo Makubate ◽  
David Alexander Munnoch
Keyword(s):  
Breast Reconstruction ◽  
Failure Rate ◽  
Retrospective Review ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Senior Author ◽  
Complication Rates ◽  
Immediate Reconstruction ◽  
Flap Failure ◽  
Increased Risk

Breast reconstruction using free tissue transfer is an increasingly utilised oncoplastic procedure. The aim was to review all bilateral breast reconstructions using abdominal free flaps by a single surgeon over an 11-year period (2003–2014). A retrospective review was performed on all patients who underwent bilateral breast reconstruction using abdominal free flaps between 2003 and 2014 by the senior author (DAM). Data analysed included patient demographics, indication for reconstruction, surgical details, and complications. Fifty-five female patients (mean 48.6 years [24–71 years]) had bilateral breast reconstruction. The majority (41, 74.5%) underwent immediate reconstruction and DIEP flaps were utilised on 41 (74.5%) occasions. Major surgical complications occurred in 6 (10.9%) patients, all of which were postoperative vascular compromise of the flap. Failure to salvage the reconstruction occurred on 3 (5.5%) occasions resulting in a total flap failure rate of 2.7%. Obesity (>30 kg/m2) and age > 60 years were shown to have a statistically increased risk of developing postoperative complications (P<0.05). Our experience demonstrates that abdominal free flaps for bilateral breast reconstruction fares well, with a flap failure rate of 2.7%. Increased body mass index and patient age (>60 years) were associated with higher complication rates.

scholarly journals RECONSTRUCTION OF UPPER LIMB SOFT TISSUE INJURIES, EXCEPT FOR FINGERTIPS LESIONS

2021 ◽  
Vol 29 (2) ◽  
pp. 81-86
Author(s):  
CARLOS ALBERTO EGUEZ JELSKI ◽  
GUSTAVO BALADORE SZENDLER ◽  
CRISTINA SCHMITT CAVALHEIRO ◽  
LUIZ ANGELO VIEIRA ◽  
EDIE BENEDITO CAETANO
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Free Flaps ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Reconstructive Procedures ◽  
Advantages And Disadvantages ◽  
Tissue Injuries

ABSTRACT Objective: The main purpose of this work was to evaluate the advantages and disadvantages of reconstructive procedures applied in upper limb soft tissue injuries according to their location. Methods: The study involved 94 male and 22 female patients (116 total) operated between April 2001 and November 2017 due to traumatic injuries in a upper limb. Individuals were evaluated considering their age, sex, etiology, reconstruction area , applied methodology and complications. The finger injuries were excluded. Results: The performed reconstruction procedures include 29 skin grafts; six advancement flaps; seven rotation flaps; 33 pedicled fasciocutaneous flaps, 9 free fasciocutaneous flaps; 5 pedicled muscle flaps; 12 free muscle flaps, three pedicled musculocutaneous flaps; one free musculocutaneous flap; 11 neurovascular free flaps. Conclusion: Reconstructive procedures in the upper limbs are diverse, varying from skin grafting to free flaps. The indication of the best option depends on the type of injurie and the surgeon. The final goal is to reach the best functional result combined with the lowest possible morbidity. Level of Evidence IV, Case series.

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

2020 ◽  
Vol 36 (04) ◽  
pp. 294-300 ◽  
Author(s):  
Lauren T. Daly ◽  
Andres F. Doval ◽  
Samuel J. Lin ◽  
Adam Tobias ◽  
Bernard T. Lee ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Wound Complications ◽  
Diep Flap ◽  
Flap Reconstruction ◽  
Fat Necrosis ◽  
Wound Breakdown ◽  
Increased Risk ◽  
Deep Inferior Epigastric Artery

Abstract Background This study examines the effect of prior abdominal surgery on flap, donor-site, and overall complications in women undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and assesses whether preoperative computed tomography angiography (CTA) affects outcomes. Methods All DIEP flaps performed at our institution between 2004 and 2015 were identified retrospectively. Patients were stratified based on a history of prior abdominal surgery and whether or not they underwent a preoperative CTA. A subgroup analysis was performed to compare operative times and incidence of complications using adjusted odds ratios (ORs). Results Over a 12-year period, 425 patients (640 flaps) had prior abdominal surgery, and 393 patients (547 flaps) had no prior abdominal surgery. Of the patients with previous abdominal surgery, 67 (15.7%) underwent preoperative CTA and 333 (78.4%) did not. Patients with prior abdominal surgery were more likely to have donor-site wound complications (OR: 1.82, 95% confidence interval [CI]: 1.15–2.87, p = 0.01), fat necrosis ≥2cm of the transferred flap (OR: 1.39, 95% CI: 1.0–1.94, p = 0.05), and were more likely to have bilateral DIEP flap reconstruction (OR: 1.61, 95% CI: 1.22–2.12, p < 0.001). Preoperative CTA did not reduce the risk of complications and did not affect operative times. Conclusion DIEP flap reconstruction can be safely performed in women with prior abdominal surgery. However, these patients should be counseled that they are at an increased risk for donor-site wound breakdown and fat necrosis of the reconstructed breast. Preoperative CTA does not reduce complication rate, overall operative time, or time needed to dissect perforators in women with abdominal scars.

scholarly journals Redefining Hindfoot Alignment Based on Pathology rather than Morphology: A Prospective Observational Diagnostic Study on 250 Feet

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0033
Author(s):  
Francois Lintz ◽  
Alessio Bernasconi ◽  
Matthew J. Welck ◽  
Céline Fernando ◽  
Cesar de Cesar Netto
Keyword(s):  
Correlation Coefficient ◽  
Weight Bearing ◽  
Large Population ◽  
Anatomical Location ◽  
Diagnostic Study ◽  
Foot And Ankle ◽  
Threshold Values ◽  
Hindfoot Alignment ◽  
Increased Risk ◽  
Spearman’S Correlation

Category: Ankle; Ankle Arthritis; Bunion; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: The analysis of the hindfoot alignment (HA) is important in the management of various foot and ankle pathologies. Foot Ankle Offset (FAO), measured using Weight Bearing CT (WBCT) scans is a 3D biometric measurement of HA described in the literature, however only with relation to the clinical morphology of the hindfoot or previously known 2D biometrics such as the hindfoot angle. The aim of this study was to observe the FAO distribution on a continuous, large population of patients and to analyze its discriminating power between pathological and non-pathological cases. We hypothesized that threshold values could be determined for the normal range of FAO in terms of risk of presenting with different pathologies in varus or valgus configurations. Methods: Prospective, IRB approved (COS-RGDS-2016-06-008-P-LINTZ-F, Clinical Trials NCT 04134962), level II study. 125 patients (250 feet) with bilateral WBCT as standard follow-up were included at a single institution. Mean age was 54 years (18-84), 58.4 % were female. Each patient was clinically evaluated, scans analyzed by a fellowship-trained foot and ankle surgeon and all degenerative pathologies classified depending on their anatomical location (medial or lateral). HA was measured using FAO on 3D datasets and Tibio-Calcaneal Angle (TCA) on 2D Saltzman-El-Khoury views. All scans were analyzed a second time by a radiology MD. FAO and TCA Intraclass Correlation Coefficient (ICCs) and Spearman’s correlation coefficient were calculated. Mean FAO values were calculated for all, normal, varus and valgus cases, and each pathology group. Receiver operating Curves (ROC), threshold values of FAO and area under the curve (AUC) were established for predicting an increased risk of medial or lateral pathologies. Results: A threshold FAO value of -1.64% was found to best predict the risk of lateral pathology (51.4% sensitivity, 85.1% specificity, AUC=0.72) and 2.71% (95% sensitivity, 82.8% specificity, AUC=0.93) for medial pathology, both versus no pathology. Mean FAO value was 1.65% +-4.72% and mean TCA was 4.15° +-7.67°. Interobserver reproducibility for FAO and TCA was respectively 0.96 [95% CI 0.95-0.97] and 0.95 [95% CI 0.94-0.96]. Spearman’s correlation coefficient between FAO and TCA was 0.697. Clinical assessment rated 167 feet as normal, 33 varus, and 50 valgus. Mean FAO values were respectively 0.99 +-3.26%, - 2.53+-5.05 % and 6.81+-2.70%. We found that the mean FAO was 0.42+-3.19 % for non-pathologic feet, -2.30+-4.58 for lateral pathologies, 6.62+-2.77 for medial pathologies. Conclusion: The most important finding in this prospective clinical trial is the description of normal HA as the FAO range in which the risk for degenerative Foot and Ankle pathology is the least: -1.64% to 2.71%. This new, pathology based prognostic approach to HA is different to the traditional morphological approach. The potential of WBCT to provide computerized, data- based and biomechanically meaningful 3D measurement tools could improve the prognostic potential of biometrics such as HA. Results will be refined in the future by increasing the size of study population.

Tranexamic Acid in Foot and Ankle Surgery: A Topical Review and Value Analysis

2021 ◽  
pp. 193864002098363
Author(s):  
William L. Johns ◽  
Kempland C. Walley ◽  
Benjamin Jackson ◽  
Tyler A. Gonzalez
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Potential Role ◽  
Wound Complications ◽  
Foot And Ankle ◽  
Value Analysis ◽  
Increased Risk ◽  
Ankle Surgery ◽  
Minimize Blood Loss ◽  
Potential Benefits

Tranexamic acid (TXA) has become a commonly used perioperative intervention in total joint arthroplasty, shoulder and knee arthroscopy, and spinal procedures in order to minimize blood loss, hematoma formation, hemarthrosis, and wound healing complications. There is a potential role for TXA use in foot and ankle procedures, with limited studies suggesting a potential benefit in minimizing postoperative wound complications and blood loss without an increased risk of thromboembolic events. In light of the profound clinical and financial impact of TXA use in other orthopaedic subspecialties and the early successes in foot and ankle surgery, we aim to provide more information about TXA and its use in foot and ankle surgery. Therefore, the purpose of this review is to perform a comprehensive literature review on the topic of TXA use in foot and ankle procedures in order to describe the pertinent available literature on the use of TXA in orthopaedic surgery and its implications specifically in foot and ankle surgery. It is our aim to identify potential benefits and shortcomings in the available evidence on TXA use for foot and ankle surgery in hopes to (1) best inform foot and ankle surgeons where beneficial and safe and (2) inspire further research on this topic as it relates to clinical management for foot and ankle patients. Levels of Evidence: Level IV

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