Soft Tissue Reconstruction Pyramid in the Diabetic Foot

2010 ◽  
Vol 3 (5) ◽  
pp. 241-248 ◽  
Author(s):  
Claire M. Capobianco ◽  
John J. Stapleton ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Weight Bearing ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Best Interest ◽  
Foot Complications ◽  
Uncontrolled Diabetes ◽  
Wound Healing Response ◽  
Tissue Reconstruction

Foot complications and ulceration are well-known sequelae to uncontrolled diabetes. Patients with chronic foot ulcers or wounds resulting from surgical debridement of deep-space infections are at continued risk for development of osteomyelitis and potential amputation. Moreover, these wounds often necessitate multiple outpatient clinic visits, daily dressing care, and prolonged periods of non—weight bearing, all of which have been shown to adversely affect the patient’s quality of life. After a prudent period of wound-healing response, the authors believe that early and aggressive soft tissue reconstruction is in the patient’s best interest and is crucial for resolution of the chronic nonhealing wound. The options for soft tissue coverage and the logical progression of application of these techniques in the diabetic foot will be described.

Soft-tissue reconstruction for recalcitrant diabetic foot wounds

1999 ◽  
Vol 38 (6) ◽  
pp. 388-393 ◽  
Author(s):  
Brenda K. Cohen ◽  
David D. Zabel ◽  
E. Douglas Newton ◽  
Alan R. Catanzariti
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

Chest Wall Reconstruction Following Tumor

2020 ◽  
Author(s):  
Farooq Shahzad ◽  
Evan Matros
Keyword(s):  
Soft Tissue ◽  
Chest Wall ◽  
Free Flaps ◽  
Chest Wall Reconstruction ◽  
Chest Wall Tumor ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Pedicled Flaps ◽  
Ablative Surgery ◽  
Tissue Reconstruction

Plastic surgeons are typically called upon to reconstruct the chest wall in four situations: oncologic resection, infections, trauma and osteoradionecrosis. In this chapter we will discuss post-oncologic reconstruction. Chest wall reconstruction following tumor resection is typically performed at the same setting as the ablative surgery; this results in quicker patient recovery and overall better outcomes. The reconstruction should be planned with the ablative surgeon so that an assessment can be made of the extent of resection and available donor sites for reconstruction. The major components of reconstruction are 1) skeletal support and 2) soft tissue coverage. Skeletal support is indicated if the defect is >5 cm, 4 or more ribs are removed or more than 2/3rd of the sternum is resected. Prosthetic mesh is most commonly used. Soft tissue reconstruction is performed with regional pedicled flaps in the vast majority of cases. Free flaps are used when regional flaps are not sufficient (large defects) or not available.  This review contains 11 figures, 3 tables, and 49 references. Keywords: chest wall, tumor, skeletal reconstruction, soft tissue reconstruction, mesh, acellular dermal matrix, titanium osteosynthesis systems, resorbable plates, pedicled flaps, free flaps

Soft tissue reconstruction of the diabetic foot

2003 ◽  
Vol 20 (4) ◽  
pp. 757-781 ◽  
Author(s):  
Gary Peter Jolly ◽  
Thomas Zgonis ◽  
Peter Blume
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

Abductor Hallucis Muscle Flap and Staged Medial Column Arthrodesis for the Chronic Ulcerated Charcot Foot With Concomitant Osteomyelitis

2010 ◽  
Vol 3 (5) ◽  
pp. 269-273 ◽  
Author(s):  
Claire M. Capobianco ◽  
Thomas Zgonis
Keyword(s):  
Soft Tissue ◽  
Wound Closure ◽  
Wound Care ◽  
Weight Bearing ◽  
Deformity Correction ◽  
Muscle Flap ◽  
Surgical Reconstruction ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Abductor Hallucis

Midfoot ulceration is a common sequela of the diabetic Charcot rocker-bottom deformity. Because redundant soft tissue from a non— weight-bearing area is often scarce in this area of the foot, soft-tissue coverage may be challenging. Wound closure may be difficult to achieve with local wound care and off-loading techniques if the predisposing deformity that caused the ulceration is not addressed. In the same setting, surgical reconstruction is often feared when open wounds are present, given the potential for infection. Approaching these wounds with a rational stepwise and staged approach is prudent to eradicate the underlying infection and also to achieve durable wound closure and long-term deformity correction. The authors present the use of a local muscle flap and circular external fixation for closure of a recalcitrant Charcot plantar-medial midfoot ulceration and also discuss different adjunctive modalities to facilitate soft-tissue reconstruction in the diabetic foot.

Soft Tissue Reconstruction

2020 ◽  
pp. 63-74
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Open Fractures ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction ◽  
Wound Excision

Soft tissue coverage of open fractures with well-vascularised tissues should be performed within 72 hours of injury or at the same time as internal fixation. It may be in the form of local or free flaps, and may comprise muscle, fasciocutaneous tissues, or both. Flap selection depends on multiple factors, including the size and location of the defect following wound excision, availability of flaps, and donor site morbidity. Local flaps are usually used to cover defects with a limited zone of injury. Anastomoses for free flaps should be performed outside the zone of injury. Experimental data suggest that coverage with muscle leads to improved healing of fractures. However, there is currently little clinical evidence to support the use of one form of soft tissue cover over another for open fractures of the lower limb. The plastic surgeon must always consider the donor site morbidity of the flap(s) chosen.

Soft Tissue Reconstruction with Diabetic Foot Tissue Loss

2019 ◽  
Vol 36 (3) ◽  
pp. 425-440 ◽  
Author(s):  
Todd A. Hasenstein ◽  
Timothy Greene ◽  
Jennifer C. Van ◽  
Andrew J. Meyr
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

scholarly journals Soft-tissue coverage for wound complications following total elbow arthroplasty

2021 ◽  
Vol 24 (4) ◽  
pp. 245-252
Author(s):  
Arno A. Macken ◽  
Jonathan Lans ◽  
Satoshi Miyamura ◽  
Kyle R. Eberlin ◽  
Neal C. Chen
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Demographic Data ◽  
Total Elbow Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Local Tissue ◽  
Elbow Arthroplasty ◽  
Tissue Reconstruction

Background: In patients with total elbow arthroplasty (TEA), the soft-tissue around the elbow can be vulnerable to soft-tissue complications. This study aims to assess the outcomes after soft-tissue reconstruction following TEA. Methods: We retrospectively included nine adult patients who underwent soft-tissue reconstruction following TEA. Demographic data and disease characteristics were collected through medical chart reviews. Additionally, we contacted all four patients that were alive at the time of the study by phone to assess any current elbow complications. Local tissue rearrangement was used for soft-tissue reconstruction in six patients, and a pedicle flap was used in three patients. The median follow-up period was 1.3 years (range, 6 months–14.7 years).Results: Seven patients (78%) underwent reoperation. Four patients (44%) had a reoperation for soft-tissue complications, including dehiscence or nonhealing of infected wounds. Five patients (56%) had a reoperation for implant-related complications, including three infections and two peri-prosthetic fractures. At the final follow-ups, six patients (67%) achieved successful wound healing and two patients had continued wound healing issues, while two patients had an antibiotic spacer in situ and one patient underwent an above-the-elbow amputation. Conclusions: This study reports a complication rate of 78% for soft-tissue reconstructions after TEA. Successful soft-tissue healing was achieved in 67% of patients, but at the cost of multiple surgeries. Early definitive soft-tissue reconstruction could prove to be preferable to minor interventions such as irrigation, debridement, and local tissue advancement, or smaller soft-tissue reconstructions using local tissue rearrangement or a pedicled flap at a later stage.

Patient and Surgical Factors Contributing to Perioperative Infection in Complex Lower Extremity Trauma

2016 ◽  
Vol 82 (10) ◽  
pp. 940-943 ◽  
Author(s):  
Karen E. Burtt ◽  
Alexis D. Rounds ◽  
Hyuma A. Leland ◽  
Ram K. Alluri ◽  
Ketan M. Patel ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Limb Salvage ◽  
Perioperative Outcomes ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Infection Rates ◽  
Lower Extremity Injuries ◽  
Tissue Reconstruction ◽  
Extremity Injuries

Infections in the traumatized lower extremity are a significant source of morbidity and expense. Outcomes after vascularized soft tissue reconstruction were analyzed to determine impact on infection rates. A retrospective review of a prospectively maintained database was performed, including 114 trauma patients requiring soft tissue reconstruction of lower extremity injuries at an urban Level I tertiary referral center from 2008 to 2015. Patient characteristics and perioperative outcomes were analyzed. After trauma, 39 (34.2%) patients developed wound infections, of which 74.4 per cent of infections occurred before soft tissue coverage. Isolated lower extremity injury yielded a 4-fold increase in the incidence of infection. Infection rates doubled in patients who smoked, sustained a fall, had a proximal third of the lower leg wound, or underwent external fixation. Comorbid diabetes, underlying fracture, and wound size were not predictive of infection. Overall, there was a 97.4 per cent rate of limb salvage after soft tissue reconstruction. In patients with infection before soft tissue reconstruction, a salvage rate of 96.6 per cent was achieved. Soft tissue reconstruction in the traumatized and infected lower extremity resulted in high limb salvage success rates, demonstrating vascularized tissue transfer in lower extremity injuries is effective in treating lower extremity infection.

scholarly journals Contemporary reconstruction after complex facial trauma

2020 ◽  
Vol 8 ◽  
Author(s):  
Matthew R Zeiderman ◽  
Lee L Q Pu
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Facial Trauma ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Reconstruction Process ◽  
Optimal Outcomes ◽  
Reconstructive Process ◽  
Tissue Reconstruction

Abstract Complex facial trauma requires complex repair and solutions. This process is challenging for the surgeon who seeks to manage the expectations of the patient and family while achieving the best possible result. Historically, the use of pedicled flaps, and then free tissue transfer, were the primary techniques utilized. Advancements in soft-tissue reconstruction, such as perforator flaps and pre-expanded and prefabricated flaps, allow refinement of the soft-tissue reconstruction process to create the best initial soft-tissue coverage. The advent of contemporary technologies, such as virtual surgical planning, stereolithography and customized implants and plates, facilitates a tailored approach to the patient’s reconstructive needs for precise bony reconstruction. When surgical and technological techniques are combined in complementary multistage reconstructions, better reconstructive and aesthetic outcomes are achievable than ever before. In this review, the authors present a summary of the management of complex facial trauma based on the senior author’s broad experience. Initial management and contemporary reconstructive techniques and technology to provide optimal outcomes are reviewed. A case series of complex facial traumas and their reconstructive process is also presented to demonstrate how complementary staged procedures can yield an optimal result. We believe the reconstructive surgeon managing complex facial trauma should strive to incorporate contemporary technologies and techniques into their armamentarium to provide the best patient care.

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