Functional Outcomes of Posttraumatic Lower Limb Salvage: A Pilot Study of Anterolateral Thigh Perforator Flaps Versus Muscle Flaps

2009 ◽  
Vol 66 (5) ◽  
pp. 1311-1314 ◽  
Author(s):  
Eduardo D. Rodriguez ◽  
Rachel Bluebond-Langner ◽  
Carol Copeland ◽  
T Nicole Grim ◽  
Navin K. Singh ◽  
...  
Keyword(s):  
Pilot Study ◽  
Limb Salvage ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Perforator Flaps ◽  
Muscle Flaps ◽  
Anterolateral Thigh

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.

Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps

2017 ◽  
Vol 34 (02) ◽  
pp. 121-129 ◽  
Author(s):  
Pierre Moullot ◽  
André M. Gay ◽  
Baptiste Bertrand ◽  
Régis Legré ◽  
Nathalie Kerfant ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Free Flaps ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Aesthetic Outcome ◽  
Anterolateral Thigh ◽  
Alt Flap

Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures. Methods We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap. Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05). Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.

scholarly journals Limb Salvage Using Combined Linking Perforator Free Flaps

2019 ◽  
Vol 19 (1) ◽  
pp. 44-50
Author(s):  
Youn Hwan Kim ◽  
Gyeong Hoe Kim ◽  
Georgios Pafitanis ◽  
Rob Miller ◽  
Sang Wha Kim
Keyword(s):  
Lower Limb ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Perforator Flaps ◽  
Limb Defects ◽  
One Stage ◽  
Anterolateral Thigh ◽  
Anterolateral Thigh Flaps ◽  
Artery Perforator

Microsurgical free tissue transfer is the most effective method for extensive reconstruction of lower limb defects. The purpose of this report is to describe our experience of using microsurgically fabricated combined linking perforator flaps for one-stage reconstruction of extensive lower limb defects. Between April 2008 and November 2016, 16 cases of extensive lower defects were reconstructed using combined linking flaps. Of the patients, 10 were males, and the mean age was 45.3 years (range = 20-76 years). The flaps used were thoracodorsal artery perforator flaps together with deep inferior epigastric artery perforator flaps or anterolateral thigh flaps. There were no total flap failures; however, 3 anterolateral thigh flaps were partially lost and required skin grafts. One wound disruption healed conservatively. Donor site healing was achieved primarily without any dehiscence. The follow-up period was 15.4 months (range = 8-24 months). The use of combined linking perforator flaps for lower limb defects is uncommon; however, in cases of extensive limb defects these flaps can salvage limbs by means of one-stage operations.

Donor-Site Morbidity of Free Muscle and Perforator Flaps: Comparison of the Gracilis Muscle Flap and the Anterolateral Thigh Flap

2017 ◽  
Vol 33 (07) ◽  
pp. 526-532 ◽  
Author(s):  
M. Rassner ◽  
J. Kiefer ◽  
H. Bannasch ◽  
G. Stark ◽  
S. Eisenhardt ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Donor Site ◽  
Muscle Flap ◽  
Donor Site Morbidity ◽  
Gracilis Muscle ◽  
Perforator Flaps ◽  
Muscle Flaps ◽  
Gracilis Muscle Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Background Both the gracilis muscle flap and the anterolateral thigh (ALT) flap have been described as successful reconstructive options for defect coverage after trauma or tumor resection. In general, free perforator flaps are considered to generate less donor-site morbidity than muscle flaps. Here, we put this hypothesis to the test. Methods In this study, 193 patients who had undergone free flap reconstruction with either free gracilis muscle flaps (n = 131) or ALT flaps (n = 62) were included. Subjective patient satisfaction with the aesthetic and functional outcome of the donor sites was assessed using a self-report questionnaire as well as the Lower Extremity Functional Scale (LEFS). Results Comparing the donor-site morbidity of free ALT and gracilis flaps, the LEFS revealed no significant differences in functional impairment (p = 0.6447) of the lower extremity. The donor-site scar was significantly longer after ALT flap harvest (mean: 21.16 cm) than after gracilis muscle flap harvest (mean: 14.17 cm; p < 0.0001). Furthermore, donor-site numbness was significantly greater in the ALT group than in the gracilis group (p = 0.0068). Conclusion No significant differences in functional impairment of the lower extremity were reported after gracilis muscle and ALT flap harvest. Regarding scar length and level of numbness of the donor site, the gracilis muscle flap was shown to be superior to the ALT flap.

scholarly journals Treatment of Upper-Extremity Sarcoma with Limb-Salvage Procedures Showed Good Functional Outcomes: A Pilot Study Of 13 Consecutive Patients

2016 ◽  
Vol 19 (7) ◽  
pp. A746-A747
Author(s):  
JP Repo ◽  
Barner-Rasmussen ◽  
G Kask ◽  
C Blomqvist ◽  
EJ Tukiainen
Keyword(s):  
Pilot Study ◽  
Upper Extremity ◽  
Limb Salvage ◽  
Functional Outcomes ◽  
Extremity Sarcoma

Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

2017 ◽  
Vol 33 (S 01) ◽  
pp. S27-S33 ◽  
Author(s):  
Martina Corno ◽  
Salvatore D'Arpa ◽  
Pietro Di Summa ◽  
Igor Pellegatta ◽  
Luigi Valdatta ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Muscle Flaps ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction ◽  
Tissue Defects

AbstractSoft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge in perforator anatomy and their mapping, a new era of lower limb reconstruction has begun. Propeller flap could be raised on any suitable perforator vessel and, without the aid of microsurgical anastomosis, used to restore small- to middle-sized soft tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous free flaps and the applicability of the propeller flaps in lower limb reconstruction.

627-P: Efficacy and Safety of Allogeneic Platelet Rich Plasma in Treatment of Diabetic Patients with Lower Limb Ulcers: A Pilot Study

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 627-P
Author(s):  
WUQUAN DENG ◽  
MIN HE ◽  
BING CHEN ◽  
YU MA ◽  
DAVID ARMSTRONG ◽  
...  
Keyword(s):  
Pilot Study ◽  
Lower Limb ◽  
Platelet Rich Plasma ◽  
Diabetic Patients ◽  
Efficacy And Safety

scholarly journals Effects of physical therapy on hyaluronan clearance and volume regulating hormones in lower limb lymphedema patients: A pilot study

2021 ◽  
Vol 104 (1) ◽  
pp. 003685042199848
Author(s):  
Bianca Brix ◽  
Gert Apich ◽  
Andreas Rössler ◽  
Sebastian Walbrodt ◽  
Nandu Goswami
Keyword(s):  
Pilot Study ◽  
Lower Limb ◽  
Time Course ◽  
Plasma Renin ◽  
Lymphatic Drainage ◽  
Invasive Treatment ◽  
Lymphatic Flow ◽  
Compression Bandaging ◽  
Complete Decongestive Therapy ◽  
Total Plasma Protein

Lymphedema is manifested as a chronic swelling arising due to stasis in the lymphatic flow. No cure is currently available. A non-invasive treatment is a 3 week complete decongestive therapy (CDT), including manual lymphatic drainage and compression bandaging to control swelling. As CDT leads to mobilization of several liters of fluid, effects of CDT on hyaluronan clearance (maker for lymphatic outflow), volume regulating hormones, total plasma protein as well as plasma density, osmolality and selected electrolytes were investigated. In this pilot study, we assessed hyaluronan and volume regulating hormone responses from plasma samples of nine patients (three males, six females, aged 55 ± 13 years) with lower limb lymphedema stage II-III, before - and after - CDT. A paired non-parametric test (Wilcoxon) was used to assess hormonal and plasma volume changes. Correlation was tested using Spearman’s correlation. The main findings of this novel study are that lymphedema patients lost volume and weight after therapy. Hyaluronic acid did not significantly change pre- compared to post-CDT. Aldosterone increased significantly after therapy, while plasma renin activity increased, but not significantly. Plasma total protein, density, osmolality and sodium and chloride did not show differences after CDT. To our knowledge, no study has previously investigated the effects of CDT on volume regulating hormones or electrolytes. To identify the time-course of volume regulating hormones and lymphatic flow changes induced by CDT, future studies should assess these parameters serially over 3 weeks of therapy.

scholarly journals Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke

2021 ◽  
pp. 154596832199904
Author(s):  
Brice T. Cleland ◽  
Sangeetha Madhavan
Keyword(s):  
Lower Limb ◽  
Functional Outcomes ◽  
Motor Pathways ◽  
Movement Accuracy ◽  
Transcallosal Inhibition ◽  
Paretic Limb ◽  
Bilateral Lower Limb ◽  
Ankle Movement ◽  
Lower Limb Movement ◽  
Clinical Measures

Background Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. Objective Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. Methods In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. Results Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb ( P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions ( P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere ( P = .002) and during dynamic than isometric conditions ( P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy ( R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry ( R2 = 0.19, P = .03). Conclusions Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.

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