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.

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.

Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot

2018 ◽  
Vol 100-B (2) ◽  
pp. 190-196 ◽  
Author(s):  
M. Chraim ◽  
S. Krenn ◽  
H. M. Alrabai ◽  
H-J. Trnka ◽  
P. Bock
Keyword(s):  
Limb Salvage ◽  
Case Series ◽  
Foot And Ankle ◽  
Charcot Arthropathy ◽  
Charcot Neuroarthropathy ◽  
Additional Surgery ◽  
Functional Scores ◽  
Compression Nail ◽  
Hindfoot Arthrodesis

Aims Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up. Patients and Methods We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70). Results The limb salvage rate was 16 of 19 limbs. Three patients had to undergo below-knee amputation due to persistent infection followed by osteomyelitis resistant to parenteral antibiotic therapy and repeated debridement. Complications including infection, hardware removal, nonunion, and persistent ulcers requiring further intervention were also observed. Postoperative functional scores revealed significant improvement compared with preoperative scores on American Orthopaedic Foot and Ankle Society (AOFAS) – Hindfoot scale, Foot Function Index (FFI), visual analogue scale (VAS), and Foot and Ankle Outcome Score (FAOS). Conclusion The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article: Bone Joint J 2018;100-B:190–6.

scholarly journals Fasciocutaneous flaps for covering foot and ankle injuries

2014 ◽  
Vol 49 (2) ◽  
pp. 183-188
Author(s):  
Alexandre Carvalho Quirino ◽  
Karen Cristina Viegas
Keyword(s):  
Ankle Injuries ◽  
Foot And Ankle ◽  
Fasciocutaneous Flaps

scholarly journals Chronic Deltoid Ligament Insufficiency Repair with Internal Brace™ Augmentation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Manuel Pellegrini ◽  
Giovanni Carcuro ◽  
Natalio Cuchacovic ◽  
Marcelo Somarriva ◽  
Mario Escudero Heldt ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Short Form ◽  
Stage Iv ◽  
Deltoid Ligament ◽  
Foot And Ankle ◽  
Ankle Pain ◽  
Ligament Repair ◽  
Sf 36 ◽  
Internal Brace

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation in foot and ankle surgery. Although numerous surgical procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex deltoid reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ (Arthrex, Inc., Naples FL, USA) device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation. Methods: After IRB approval, a prospective study was conducted. Patients were included if they were older than 18 years, presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with less than six months of follow-up, stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded from the study. CDLI diagnosis was confirmed intraoperatively with the arthroscopic ankle drive-through sign. Patients were evaluated preoperatively and postoperatively using foot and ankle ability measure (FAAM) score, 36-item short form survey (SF-36), and grade of satisfaction. Paired t-tests were used to assess the pre- and postoperative FAAM and SF-36 scores. Results: Eleven patients met inclusion criteria. Nine patients were male and two female, with a mean age of 32 (18-61). Six ankles were right and five left. 88% presented with medial ankle pain, 67% medial drawer, 88% asymmetric hindfoot valgus, and 44% multidirectional ankle instability. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<0.05). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated. Conclusion: Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up.

scholarly journals Functional outcomes and return-to-sports rate after modified Brostrom repair for lateral ankle instability with absorbable sutures and immediate postoperative weightbearing

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000 ◽  
Author(s):  
Somen Agrawal ◽  
Greg Keene ◽  
James Clayton
Keyword(s):  
Functional Outcomes ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Return To Sport ◽  
Cost Effective ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Absorbable Sutures ◽  
Lateral Ankle Instability

Category: Sports Introduction/Purpose: The ankle is commonly injured in sporting activities occurring in up to 1 in 10,000 people a day. About 80% of ankle sprains recover with nonoperative management, with the remaining 20% of patients developing symptomatic instability requiring surgery. There are various surgical options being used, including anatomic repair (Brostrom technique and modifications), anatomic recon- struction with autograft or allograft, and nonanatomic reconstructions such as the Watson-Jones, Evans, and Chrisman-Snook procedures. The outcome of the direct anatomic repair is likely dependent on tissue quality, ability to tension the ligaments, and the security of the fixation. Secure fixation is critical to enable an early rehabilitation without compromising clinical outcome. We hypothesized that using absorbable suture for anatomic reconstruction is not only cost effective but also allows early rehabilitation with immediate postoperative weightbearing with good functional outcomes. Methods: The study included 71 patients presenting with chronic lateral ankle instability (who failed non-operative management) who underwent modified Brostrom repair by a single surgeon between Jan 2012 and Feb 2014.The anterior talofibular ligament and calcaneo- fibular ligament were anatomically repaired , and the repair was augmented with inferior extensor retinaculum proximal advancement, both with 1 vicryl suture. Full weight bearing in normal shoe was allowed from the day of surgery. Physiotherapy commenced prior to discharge from day surgery with gentle active range of motion, calf strength, and static peroneii exercises. From 3 to 4 weeks proprioceptive, theraband, and dynamic peroneal exercises were started. No boots, braces, or casts were used at any stage in the post-operative period. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score (FAOS). Complication, failure (recurrent instability), and return-to-sport rates were also recorded. Results: There were 41 were males and 30 females with mean age at surgery of 27 years (range 16 - 47 years), mean duration of symptoms of 2 years (range, 6 months to 8 years)and a mean follow-up duration of 34 months (range 24- 49 months). Significant improvement was seen in the FAOS from preoperatively to postoperatively (from 37 to 79): the pain subscale , the symptom subscale, the function subscale, the function in sports and recreation subscale, and the foot and ankle–related quality of life subscale improved from 38 to 79, 42 to 81, 43 to 82 , 31 to 79 and 32 to 77 respectively. All these findings were statistically significant. The failure rate was 4%, with 3 patients reporting instability after subsequent traumatic re-rupture. Two case of temporary neuropraxia of the superficial peroneal nerve was observed. Fifty four out of 71 patients were involved in sports prior to injury and forty seven (87%) returned to sport after reconstruction. Conclusion: This study demonstrates that lateral ligament reconstruction using absorbable sutures is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weight bearing. This allows a cost-effective approach to management with minimal impact on a patient’s activities of daily living in the post-operative period. The procedure also has high return-to-sport rate.

scholarly journals Evaluation of functional outcome following ORIF of bimalleolar fractures of the ankle-A prospective study of 30 patients

2020 ◽  
Vol 11 (4) ◽  
pp. 6051-6055
Author(s):  
Yeshwanth subash ◽  
Vishnu S ◽  
Damodharan
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Early Mobilization ◽  
Foot And Ankle ◽  
The Mean ◽  
American Orthopaedic ◽  
A Prospective Study ◽  
Mean Time

Bimalleolar fractures are common injuries, and stable fracture patterns can be treated conservatively, while complicated, unstable fractures would require surgical intervention. This study aimed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures. This was a study of 30 patients with bimalleolar fractures who presented between January 2013 to January 2016 treated with ORIF with a follow-up period of 3 years. Functional outcome was performed with the AOFAS (American Orthopaedic Foot and ankle society) score. The mean age of the patients was 41.6 years. There was a female preponderance seen in our study with the left side being more commonly affected. The mean time to fracture union was 12.13 weeks, and we had excellent outcomes in 18 patients, good in 10, while two patients had a fair result. We did not lose any of our patients to follow up. All of our patients were happy with the functional outcome achieved. No significant complications were seen in our study. ORIF in bimalleolar fractures enables restoration of the ankle mortise to an anatomical position and facilitates early mobilization of the ankle resulting in good functional outcomes.

scholarly journals Clinical and Functional Outcomes using the Kyocera Modular Limb Salvage System for Lower Extremity Reconstruction

2020 ◽  
Author(s):  
Donnel Alexis Ting Rubio ◽  
Katsuhiro Hayashi ◽  
Norio Yamamoto ◽  
Toshiharu Shirai ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Salvage Surgery ◽  
Valgus Deformity ◽  
Limb Salvage Surgery ◽  
Superficial Infection ◽  
Prosthesis Survival ◽  
Tumor Group

Abstract Background: Segmental metallic endoprostheses are widely used and important in reconstructive procedures of the lower limb. Most of the currently available endoprostheses are made in Europe or the United States of America and are too large for Asian knees. The Japanese Musculoskeletal Oncology Group developed a tumor prosthesis better suited for Asian skeletal anatomy, the Kyocera Modular Limb Salvage System (KLS).Methods: We performed a retrospective review of the records of patients who underwent reconstruction using KLS implants. Thirty-five patients fulfilled the inclusion criteria, 20 having undergone limb salvage surgery for tumor and 15, joint arthroplasty. Functional outcomes were evaluated using the revised Musculoskeletal rating scale for the tumor group and the Japanese Orthopedic Association Knee Score for the arthroplasty group. Complications and survivorship of the implants were also assessed.Results: At the latest follow-up, in the tumor group, 13 were alive with no evidence of recurrence, 6 died of disease, and 1 was alive with evidence of disease. The average MSTS scores on latest follow-up were 63 for the proximal femur, 67 for the distal femur, and 92 for the proximal tibia. The mean prosthesis survival was 28 months. Complications include 4 cases of aseptic loosening, 2 deep infections, 1 superficial infection, 1 valgus deformity, 2 periprosthetic fractures, 2 incidences of excessive polyethylene wear, and 2 local tumor recurrences. In the arthroplasty group, 1 patient had a persistent low grade infection on the latest follow-up. The post-operative JOA score was 61(mean). Complications included 3 cases of aseptic loosening, 2 deep infections, 2 implant failures, 1 superficial infection, 1 valgus deformity, and 1 soft tissue defect.Conclusion: Early results of the KLS implant system are encouraging, with comparable clinical outcomes to other systems in the literature. A longer follow-up study with increased numbers of patients is necessary to further validate the functional outcomes and prosthesis survival using the KLS system for limb salvage surgery.

Long-term Follow-up Results of Buechel-Pappas Ankle Arthroplasty

2019 ◽  
Vol 40 (5) ◽  
pp. 553-561 ◽  
Author(s):  
Sajeeban Krishnapillai ◽  
Boudijn Joling ◽  
Inger N. Sierevelt ◽  
Gino M.M.J. Kerkhoffs ◽  
Daniël Haverkamp ◽  
...  
Keyword(s):  
Survival Rate ◽  
Functional Outcomes ◽  
Joint Disease ◽  
Foot And Ankle ◽  
Inflammatory Joint Disease ◽  
Sf 36 ◽  
Significant Difference ◽  
The Mean

Background: Total ankle replacement (TAR) is gaining popularity as a treatment option for ankle osteoarthritis. Long-term implant survival is a critical outcome to determine the success of the TAR implant. The Buechel-Pappas (BP) implant is a second-generation mobile bearing implant. The aim of this study was to analyze the BP implant survivorship at 10-year follow-up, make a subanalysis between patient groups, and evaluate long-term functional outcomes. Methods: Data of 86 patients who received 101 BP implants between 1993 and 2010 were obtained from a prospectively documented database. Subanalyses were done for patients diagnosed with inflammatory joint disease and noninflammatory joint disease, and patients with preoperative tibiotalar neutral and nonneutral alignment. A Kaplan-Meier curve was used for survival analysis. Long-term functional outcomes were assessed with the following patient-reported outcome measures: Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Stand Version 2.0 Health Survey and 3 anchor questions. Results: The survival rate of the BP implant at 10 years was 86% (95% confidence interval, 78%-93%). A total of 31 patients (36%) required 55 reoperations, and in 13 patients (15%) a revision procedure was performed. In this series, no significant difference in 10-year survival rate was found between neither the inflammatory joint disease and noninflammatory joint disease group ( P = .47), nor the tibiotalar neutral and nonneutral alignment group ( P = .16). At a mean follow-up of 16.8 years for 21 patients, the mean FAOS activities of daily living (ADL) and FAAM ADL subscale scores were 75/100 and 56/100 points. The mean physical component summary (PCS) and mental component summary (MCS) of the SF-36 were 34/100 and 51/100 points, respectively. Conclusion: A survival rate of 86% was found at 10-year follow-up for the Buechel-Pappas implant. Our series demonstrated no significant difference in 10-year survival rates between the 2 patient subgroups. Long-term results of the various functional outcomes varied between poor and moderate. Level of Evidence: Level II, prospective cohort study.

TONGUE MICROSURGICAL RECONSTRUCTION IN PATIENTS WITH ORAL CANCER. FUNCTIONAL OUTCOMES

2019 ◽  
Vol 65 (1) ◽  
pp. 88-93
Author(s):  
Pavel Polyakov ◽  
Aleksandr Mordovskiy ◽  
Mikhail Ratushnyy ◽  
O. Matorin ◽  
Irina Rebrikova ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Serratus Anterior Muscle ◽  
Flap Necrosis ◽  
Serratus Anterior ◽  
Microsurgical Reconstruction ◽  
Oncology Research ◽  
Free Air ◽  
Radial Forearm ◽  
Tongue Reconstruction

Objectives: present our experience tongue microsurgical reconstruction in patients with oral caner Т2-Т4аN+M0. Material and methods: prospective study of cases reconstruction of oropharyngeal zone defects after radical operations for cancer from 2015 to 2017 in microsurgery department P. Hertsen Moscow Oncology Research Institute. Total 18 patients included in our study. We used flaps for reconstruction of post-resection defects: small intestine flap (2), radial forearm flap (10), thoracodorsal flap (2) chimeric thoracodorsal flap LDM+ serratus anterior muscle (4). Results: Reconstruction was successfully completed in 94 % of patients. In all cases was not flap necrosis. Mean follow-up was 16 months. Patients were free air - 89%. Patients were able to feed entirely by mouth - 83%. Speech function was completely restored in 82% of patients after operation. Spontaneous sensory re-innervation occurred in 35% of cases. One patient noted motor neuronal re-innervation. By the end of the 6th month after the operation, speech function was completely restored in 82% of patients. Conclusions: Attention to the principles of tongue reconstruction and knowledge of the range of available reconstructive options can result in more favorable functional outcomes.

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