The Essential Local Muscle Flaps for Lower Extremity Reconstruction

2020 ◽  
Author(s):  
Andrew Atia ◽  
Rebecca Vernon ◽  
Bryan J. Pyfer ◽  
Ronnie L. Shammas ◽  
Scott T. Hollenbeck
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Lower Extremity ◽  
Postoperative Management ◽  
Soft Tissue Defects ◽  
Muscle Flaps ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Tissue Defects

Abstract Background Lower extremity reconstruction is often a challenging prospect with major implications on a patient’s quality of life. For complex defects of the lower extremity, special consideration must be given to ensure suitable and durable coverage. In the following article, we present the essential local muscle flaps for lower extremity reconstruction and discuss guiding principles for the reconstructive surgeon to consider. Methods A thorough literature review was performed using PubMed to identify commonly used local muscle flaps for lower extremity reconstruction. Common considerations for each identified flap were noted. Results The essential local muscle flaps for lower extremity reconstruction were identified and classified based on anatomical region of the defect to be reconstructed. General considerations and postoperative management were discussed to aid in operative decision making. Conclusion While many factors must be taken into account when performing lower extremity reconstruction, there are numerous reliable local muscle flaps which can be used to successfully provide durable coverage for a variety of soft tissue defects of the lower extremity.

scholarly journals Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

2020 ◽  
Author(s):  
Emrah Aydogan ◽  
Stefan Langer ◽  
Christoph Josten ◽  
Johannes Maria Karl Fakler ◽  
Ralf Henkelmann
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Lower Leg ◽  
Outcome Data ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Closed Fractures ◽  
The Mean ◽  
Tissue Defects

Abstract Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after one year.Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

Importance of Vascularity and Selecting the Recipient Vessels of Lower Extremity Reconstruction

2020 ◽  
Author(s):  
Joon Pio Hong ◽  
Changsik John Park ◽  
Hyunsuk Peter Suh
Keyword(s):  
Decision Making ◽  
Lower Extremity ◽  
Free Flaps ◽  
Recipient Vessel ◽  
Multiple Factors ◽  
Surrounding Environment ◽  
The Status ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

Abstract Background Successful lower extremity reconstruction using free flaps begins by identifying a good recipient vessel and understanding the surrounding environment of the defect. Methods One should consider multiple factors when selecting the recipient vessel such as the status of the axial arteries, trying to preserve flow as much as possible, extent and severity of the defect, and ultimately what type of anastomosis will be ideal. Results Multiple factors of importance are reviewed and show the relevance in decision making and provide an algorithm. Conclusion In addition to the multiple factors to be considered, the ultimate decision should be made on the table during surgery when the actual artery or vein is exposed and shows signs of good pulsation and flow.

scholarly journals Reconstructive Outcomes of Extensive Soft-Tissue Defects after Palliative Mastectomy for Advanced Breast Cancer

2021 ◽  
Vol 17 (3) ◽  
pp. 169-177
Author(s):  
Taekeun Yoon ◽  
Soo Jin Woo ◽  
Ung Sik Jin
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Soft Tissue ◽  
Life Expectancy ◽  
Split Thickness Skin Graft ◽  
Tram Flap ◽  
Soft Tissue Defects ◽  
Thickness Skin ◽  
Tissue Defects

Background: In advanced breast cancer, reconstruction can be performed depending on the patient’s situation, and can improve the subsequent treatment and quality of life. We examined the effect of reconstruction after palliative mastectomy on survival and quality of life.Methods: Between April 2010 and April 2021, 40 patients underwent reconstruction after palliative mastectomy for stage-IV breast cancer. To evaluate postoperative satisfaction, changes in the global health and quality-of-life scores after reconstruction were evaluated using questionnaires by the European Organisation for Research and Treatment of Cancer. The survival rate according to reconstructive surgery was estimated by the Kaplan-Meier survival analysis.Results: Reconstruction methods included free transverse rectus abdominis musculocutaneous (TRAM) flap (n=3), pedicled latissimus dorsi (LD) flap (n=3), pedicled TRAM flap (n=2), pedicled LD with pedicled vertical rectus abdominis musculocutaneous flap (n=1), tissue expander insertion (n=3), and split-thickness skin graft (n=28). There were no major complications or decreased life expectancy due to reconstruction. All patients healed well and started conventional chemoradiotherapy at 31.3 days postoperatively. The quality-of-life scores increased from 37 to 83 after reconstruction. There was no difference in the survival rates between those who underwent reconstruction with split-thickness skin graft and flap operation (P>0.05). The mean survival time postoperatively was 43.9 months.Conclusion: Compared to primary closure, reconstruction of extensive soft-tissue defects after palliative mastectomy did not affect life expectancy or delay postoperative chemoradiotherapy; it led to an improved quality of life. Therefore, the extensive defects expected after palliative mastectomy should not influence indications for reconstruction surgery.

scholarly journals Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emrah Aydogan ◽  
Stefan Langer ◽  
Christoph Josten ◽  
Johannes Karl Maria Fakler ◽  
Ralf Henkelmann
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Lower Leg ◽  
Outcome Data ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Closed Fractures ◽  
The Mean ◽  
Tissue Defects

Abstract Background Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

A Simple and Convenient Alternative for the Reconstruction of Lower Extremity Soft Tissue Defects due to Different Types of Etiologies: Bipedicled Flap

2021 ◽  
pp. 153473462110094
Author(s):  
Zeynep Altuntaş ◽  
Mahmut Tekecik ◽  
Mehmet Dadacı
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Soft Tissues ◽  
Soft Tissue Defects ◽  
Peripheral Vascular ◽  
Muscle Flaps ◽  
Limited Mobility ◽  
Different Types ◽  
Neurovascular Structures ◽  
Tissue Defects

Reconstruction of soft tissue defects in the lower extremity due to different etiologies can be a challenging process for surgeons. Compelling reasons for reconstruction include the anatomy of the lower extremity, limited mobility of soft tissues especially the presence of bone, tendon, and neurovascular structures under the defect, and the exposed fixation materials make these defects more complicated. Local fasciocutaneous and muscle flaps are frequently used for the reconstruction of these defects. The patients in our study were with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 42 patients (29 male and 13 female), we present a reconstruction with a bipedicled flap as a safe, simple, and efficient reconstructive modality in the treatment of lower extremity soft tissue defects. Except for 1 total flap loss, all defects were successfully reconstructed without any major complications. When reconstruction is performed with a bipedicled flap, the main neurovascular structures are not damaged, free flap and other locoregional flaps can be used as a salvage protocol.

Quality of life in patients with oral hard or soft tissue defects after reconstructive microsurgery

2020 ◽  
Author(s):  
Alexander K. Bartella ◽  
Mohammad Kamal ◽  
Deborah Gerwing ◽  
Dirk Halama ◽  
Anita Kloss-Brandstätter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Soft Tissue Defects ◽  
Reconstructive Microsurgery ◽  
Tissue Defects

scholarly journals Study of the Dosing Tissue Distraction Clinical Efficacy in the Soft Tissue Defects Treatment of Various Etiologies in the Lower Extremities

2019 ◽  
Vol 14 (2) ◽  
pp. 36-44
Author(s):  
S. N. Pyatakov ◽  
V. A. Porhanov ◽  
V. M. Bensman ◽  
A. G. Baryshev ◽  
S. N. Pyatakova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Infectious Complications ◽  
Long Term Results ◽  
Soft Tissue Defects ◽  
Duration Of Treatment ◽  
Treatment Standard ◽  
Reconstructive Operations ◽  
Tissue Defects

Justification The most methods of extensive skin and soft tissue defects are aimed at accelerating wound healing and preventing infectious complications. To improve the effectiveness of such defects treatment, a method of dosed tissue distraction (MDTD) is used, consisting in the application of a continuously acting load to the area of healthy soft tissue in close proximity to the wound defect. Purpose It performed the evaluation of the medico-social effectiveness of the introduction into clinical practice of developed methods and devices for implementing MDTD in the treatment of skin and soft tissue defects of the extremities. Methods 407 patients were treated with wound defects of the extremities, which were divided into two groups: the main group – 198 patients in whose treatment MDTD was applied using original methods and devices; comparison group – 209 patients, in whose treatment standard treatment methods were applied. Comparison of the long-term results of treatment according to the frequency of repeated operations, complications, indicators of quality of life, frequency of disability. Results The use of MDTD is characterized by better performance compared with the use of standard approaches. There is a decrease in the frequency of performing reconstructive plastic surgery after inpatient treatment (9-10 times), remote complications by 2.6 times, a reduced value of the Vancouver scale (by 28.8%), quality of life indicators higher levels. The use of the proposed approach is characterized by a shorter duration of treatment (by 26.0%), duration of disability (1.4 times), cases of disability (2.2 times). Conclusion The use of MDTD is characterized by high medical and social efficiency, allows to reduce the cost of treating extensive skin and soft tissue defects by reducing the length of hospitalization, the frequency of repeated rehabilitation and reconstructive operations, accelerated recovery of patients, improving the quality of life and reducing the incidence of disability

scholarly journals Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study

2020 ◽  
Author(s):  
Emrah Aydogan ◽  
Stefan Langer ◽  
Christoph Josten ◽  
Johannes Maria Karl Fakler ◽  
Ralf Henkelmann
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Lower Leg ◽  
Outcome Data ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Closed Fractures ◽  
The Mean ◽  
Tissue Defects

Abstract Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after one year.Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

scholarly journals Outcomes of tissue reconstruction in distal lower leg fractures: a retrospective cohort study 

2020 ◽  
Author(s):  
Emrah Aydogan ◽  
Stefan Langer ◽  
Christoph Josten ◽  
Johannes Maria Karl Fakler ◽  
Ralf Henkelmann
Keyword(s):  
Quality Of Life ◽  
Soft Tissue ◽  
Lower Leg ◽  
Outcome Data ◽  
Soft Tissue Defects ◽  
Tissue Reconstruction ◽  
Closed Fractures ◽  
The Mean ◽  
Tissue Defects

Abstract Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage.Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores.Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after one year.Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

Gracilis and Rectus Abdominis Flaps for Leg and Foot Reconstruction

2019 ◽  
pp. 897-908
Author(s):  
Alessandro G. Cusano ◽  
Lee L. Q. Pu ◽  
Michael S. Wong
Keyword(s):  
Lower Extremity ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Muscle Flaps ◽  
Case Examples ◽  
Flap Design ◽  
Lower Extremity Reconstruction ◽  
Foot Reconstruction ◽  
Extremity Reconstruction

Distal third wounds of the lower extremity are challenging to reconstruct because vital structures are frequently exposed and local options are often limited. Free tissue transfer is regarded as the reconstructive gold standard for defects of the distal leg, ankle, and foot. The gracilis and rectus abdominis muscle flaps have proved reliable for free flap reconstruction of the distal lower extremity. This chapter provides a general approach to lower extremity reconstruction and highlights the role of the gracilis and rectus abdominis muscles and musculocutaneous flaps in the reconstruction of the distal lower extremity. Each flap is reviewed with special attention given to its indications, contraindications, anatomy, preoperative preparation, room setup, flap design, and harvest, as well as to donor site management. Considerations for flap inset and anastomosis as well as postoperative care are also discussed. Four case examples are also provided.

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