Perforator Free Flap Coverage of Chronic Lower Extremity Ulcers in Patients With Autoimmune Diseases Under Immunosuppression

2020 ◽  
pp. 153473462091961
Author(s):  
Sang Wha Kim
Keyword(s):  
Lower Extremity ◽  
Autoimmune Diseases ◽  
Free Flap ◽  
Donor Site ◽  
Wound Dehiscence ◽  
High Rate ◽  
Flap Transfer ◽  
Epigastric Artery ◽  
Free Flap Transfer ◽  
Deep Inferior Epigastric Artery

Objectives. Lower extremity ulcers are quite common in patients with autoimmune diseases. Due to chronic use of immunosuppressants, these wounds may develop into deeper wounds resulting in exposure of bone or tendon, which in turn may require free tissue transfers for coverage. The author reviewed perforator free flap transfers performed in this group of patients and analyzed the results. Methods. A retrospective review was performed on all patients who underwent perforator free flap transfer for coverage of lower extremity ulcers without trauma, over a 10-year period. Patient demographics, administered immunosuppressants, and flap and donor site complications were analyzed. Results. Twenty-two perforator free flap transfers were performed in patients with autoimmune diseases, including 18 thoracodorsal perforator flaps, 2 anterolateral thigh flaps, and 2 deep inferior epigastric artery flaps. There was no total flap loss, but there was a high rate of partial flap necrosis (40.9%) and wound dehiscence (40.9%). Intake of corticosteroids was significantly associated with postoperative complications ( P < .05). Conclusion. As partial loss of flap and wound dehiscence is much more common in this group of patients, treatment may take longer, and a fully informed consent should be obtained preoperatively. Surgeons should not avoid performing perforator free flap transfers in patients with autoimmune diseases under immunosuppression; instead, much more preparation and caution are required.

Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

2017 ◽  
Vol 33 (08) ◽  
pp. 557-562
Author(s):  
Ji Yim ◽  
Yeon Lee ◽  
Young Kim ◽  
Eun Kim ◽  
Taik Lee ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Vascular Pedicle ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Time Required ◽  
Artery Perforator

Background Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.

The Role of Free Flaps in the Treatment of Persistent Scalp Osteomyelitis

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-64-ONS-67 ◽  
Author(s):  
Willy D. Boeckx ◽  
René R.W.J. van der Hulst ◽  
Lloyd V. Nanhekhan ◽  
Francesca De Lorenzi
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Muscle Flap ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Surgical Debridement ◽  
Neurosurgical Procedures ◽  
Latissimus Dorsi Muscle Flap ◽  
Flap Transfer ◽  
Free Flap Transfer

Abstract OBJECTIVE: To evaluate the efficacy of the combination of an extensive surgical debridement and simultaneous free flap repair in case of troublesome cranial osteomyelitis. METHODS: Five patients with persistent, frontal bone osteomyelitis were treated with surgical debridement of the infected bone and reconstruction with a free flap. In all patients, osteomyelitis occurred after neurosurgical procedures and lasted from 1 to 7 years. A latissimus dorsi muscle flap with a split skin graft has been performed. RESULTS: No flap failure occurred and donor site morbidity was negligible. No signs of osteomyelitis or soft tissue infection were observed during the mean follow-up period of 3.2 years. Furthermore, the contour of the cranium could be preserved without a need for bone grafts or implants. CONCLUSION: In our experience, the combination of an extensive surgical debridement and a free flap transfer is demonstrated to be an effective treatment for “chronic” osteomyelitis of the cranium.

scholarly journals Timing of management of severe injuries of the lower extremity by free flap transfer

2005 ◽  
Vol 5 (4) ◽  
pp. 7-13 ◽  
Author(s):  
Ulf Dornseifer ◽  
Milomir Ninković
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Free Flap ◽  
High Energy ◽  
Soft Tissue Defect ◽  
Severe Injuries ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Aesthetic Results ◽  
Flap Closure

Covering defects by free-tissue transfers enable surgeons to reconstruct or salvage the lower extremity injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerve. The timing of the reconstruction using flaptechniques is extremely important. It can be divided into three categories: "primary free flap closure" (12 to 24 hours), "delayed primary free flap closure" (2 to 7 days), and "secondary free flap closure" (after 7 days). Our treatment of choice in an isolated complex injury of a lower extremity with a soft tissue defect is "primary free flap closure" providing improved funcional and aesthetic results, and psychologically benefit through lowered morbidity of the patient.

Porcine experimental model for gracilis free flap transfer to the head and neck area with novel donor site description

2020 ◽  
Vol 73 (1) ◽  
pp. 111-117
Author(s):  
José A. González-García ◽  
Carlos M. Chiesa-Estomba ◽  
Ekhiñe Larruscain ◽  
Leire Álvarez ◽  
Jon A. Sistiaga
Keyword(s):  
Head And Neck ◽  
Experimental Model ◽  
Free Flap ◽  
Donor Site ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Neck Area

Domino Free Flap Transfer Using a Superficial Circumflex Iliac Artery Perforator Flap for the Toe Flap Donor Site

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yuma Fuse ◽  
Takumi Yamamoto ◽  
Takashi Kageyama ◽  
Hayahito Sakai ◽  
Reiko Tsukuura ◽  
...  
Keyword(s):  
Free Flap ◽  
Iliac Artery ◽  
Donor Site ◽  
Perforator Flap ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Artery Perforator

Assessment of Donor-Site Morbidity Using Balance and Gait Tests After Bilateral Fibula Osteoseptocutaneous Free Flap Transfer

2009 ◽  
Vol 62 (3) ◽  
pp. 246-251 ◽  
Author(s):  
Jeng-Yee Lin ◽  
Risal Djohan ◽  
Michael Dobryansky ◽  
Shih-Wei Chou ◽  
Wen-Hsuan Hou ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Flap Transfer ◽  
Free Flap Transfer

scholarly journals Free Flap Transfer to Preserve Main Arterial Flow in Early Reconstruction of Open Fracture in the Lower Extremity

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mitsuru Nemoto ◽  
Shinsuke Ishikawa ◽  
Natsuko Kounoike ◽  
Takayuki Sugimoto ◽  
Akira Takeda
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Free Flap ◽  
Open Fracture ◽  
Posterior Tibial Artery ◽  
Flap Transfer ◽  
Posterior Tibial ◽  
Free Flap Transfer ◽  
Flow Through ◽  
Tissue Defects

The selection of recipient vessels is crucial when reconstructing traumatized lower extremities using a free flap. When the dorsalis pedis artery and/or posterior tibial artery cannot be palpated, we utilize computed tomography angiography to verify the site of vascular injury prior to performing free flap transfer. For vascular anastomosis, we fundamentally perform end-to-side anastomosis or flow-through anastomosis to preserve the main arterial flow. In addition, in open fracture of the lower extremity, we utilize the anterolateral thigh flap for moderate soft tissue defects and the latissimus dorsi musculocutaneous flap for extensive soft tissue defects. The free flaps used in these two techniques are long and include a large-caliber pedicle, and reconstruction can be performed with either the anterior or posterior tibial artery. The preparation of recipient vessels is easier during the acute phase early after injury, when there is no influence of scarring. A free flap allows flow-through anastomosis and is thus optimal for open fracture of the lower extremity that requires simultaneous reconstruction of main vessel injury and soft tissue defect from the middle to distal thirds of the lower extremity.

Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery

2018 ◽  
Vol 34 (04) ◽  
pp. 293-299 ◽  
Author(s):  
Qing Ruan ◽  
Shawn Diamond ◽  
Scott Zimmer ◽  
Matthew Iorio
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Microvascular Reconstruction ◽  
Safety And Efficacy ◽  
Flap Transfer ◽  
Pain Scores ◽  
Patient Morbidity ◽  
Free Flap Transfer ◽  
The Mean

Background Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. Methods A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed. Patients were matched into groups based on PNC utilization. The use of intravenous narcotics including patient-controlled analgesia (PCA), oral narcotics, antiemetics, length of stay (LOS), associated pain scores, flap-related performance, and patient morbidity was recorded. Results Of 48 patients who underwent lower extremity free tissue transfer, 35 satisfied criteria for comparison. Of these, PNC was utilized in 83%. The mean pain score in the immediate postoperative period was 3.84 ± 2.47 (10-point Likert scale). PCA and narcotic use were decreased in the PNC group, and no adverse effects of the catheter were identified. Microsurgical outcomes were not adversely affected in comparison. Conclusion PNC utilization for lower extremity free flap transfer significantly reduced concurrent narcotic use and attained a shorter LOS. The technique provided for safe analgesia during lower extremity free flap reconstructions satisfying the microsurgeon and the anesthesiologist.

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