The proximally‐based sural artery flap for coverage of soft tissue defects around the knee and on the proximal third and middle third of the lower leg

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved.

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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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Hyperbaric Oxygenation Treatment Combined with Peroneal Artery Perforator Flap on the Soft Tissue Defects of the Lower Leg at High Altitude

Hans Journal of Surgery ◽

10.12677/hjs.2019.83010 ◽

2019 ◽

Vol 08 (03) ◽

pp. 59-63

Author(s):

红让董

Keyword(s):

Soft Tissue ◽

High Altitude ◽

Hyperbaric Oxygenation ◽

Perforator Flap ◽

Lower Leg ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Artery Perforator ◽

Tissue Defects

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The Effect of Medial Sural Artery Perforator Flap on Reconstruction of Soft Tissue Defects

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000007294 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Qiang Xu ◽

Shou-Cheng Yin ◽

Xing-Zhou Su ◽

Si-Min Wang ◽

Yi-Hao Liu ◽

...

Keyword(s):

Soft Tissue ◽

Perforator Flap ◽

Soft Tissue Defects ◽

Sural Artery ◽

Artery Perforator ◽

Tissue Defects

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Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2011.06.047 ◽

2011 ◽

Vol 64 (12) ◽

pp. 1613-1620 ◽

Cited By ~ 37

Author(s):

M. Erol Demirseren ◽

Kamran Efendioglu ◽

C. Ozerk Demiralp ◽

Kasim Kilicarslan ◽

Huseyin Akkaya

Keyword(s):

Soft Tissue ◽

Clinical Experience ◽

Reverse Flow ◽

Perforator Flap ◽

Lower Leg ◽

Soft Tissue Defects ◽

Anterolateral Thigh ◽

Tissue Defects

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

10.21203/rs.3.rs-26620/v4 ◽

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.

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Plastic surgery of extensive soft tissue defects of the lower leg in children with the use of a parotid flap after its prefabrication with tissue expanders (preliminary report)

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors25799 ◽

2020 ◽

Vol 8 (2) ◽

pp. 197-206

Author(s):

Olga V. Filippova ◽

Anton V. Govorov ◽

Yaroslav N. Proshchenko ◽

Konstantin A. Afonichev ◽

Natalia S. Galkina

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Plastic Surgery ◽

Scar Tissue ◽

Lower Leg ◽

Soft Tissue Defects ◽

Tissue Expanders ◽

Donor Area ◽

Tissue Defects

Background. Extensive deep soft tissue defects in children are an indication for the microsurgical reconstruction using autotransplantation of a tissue complex. The use of a flap prefabrication before their microsurgical transplantation to various segments and areas is a promising approach in reconstructive surgery. Aim. The aim of this study was to evaluate the possibilities and immediate results of plastic surgery of extensive soft tissue defects of the lower leg with a tissue complex, after its prefabrication with a tissue expander, and the state of the donor area in different surgical treatment options. Materials and methods. Six patients aged 13 2.3 years were operated on for deep scar deformities of the lower leg and foot. For plastic surgery, a pericarpial flap was used. In two patients, the flap was prefabricated with tissue expanders at a volume of 720 ml. After filling the expander, the second stage of surgical treatment was performed. First, the expander was removed. Next, the flap on the artery surrounding the scapula was isolated. Last, it was transplanted into a soft tissue defect of the lower leg with the imposition of microvascular anastomoses. A layer-by-layer suture was applied to the donor wound. The Vancouver scale was used to assess the quality of the scar tissue in the donor area. Results. The removal of the tissue complex after the prefabrication with expanders made it possible to perform plastic surgery of extensive soft tissue defects of the lower leg in one stage of surgical treatment with the application of a cosmetic suture in the donor area. There were no complications in the postoperative period. At the examination after six months, patients who did not undergo flap prefabrication complained of cosmetic defects and discomfort when moving in the donor area. The evaluation of the quality of scar tissue by the Vancouver scale showed that the scars in patients after flap prefabrication were similar to optimal (total score in two patients is 2). In two patients without flap prefabrication, the total score was 7, and in two patients, it was 9, which indicated unsatisfactory cosmetic parameters of the postoperative scar. Conclusion. The prefabrication of a tissue complex using tissue expanders before microsurgical transplantation enables the collection of a large volume of tissue for plastic surgery of extensive defects. It also reduces the risk of trophic complications in the postoperative period and creates optimal conditions for closing the donor site.

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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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