A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

2018 ◽  
Vol 12 (5) ◽  
pp. 432-438 ◽  
Author(s):  
Chahine Assi ◽  
Camille Samaha ◽  
Moussa Chamoun Moussa ◽  
Tony Hayek ◽  
Kaissar Yammine
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Low Frequency ◽  
Group Versus ◽  
Healing Time ◽  
Diabetic Patients ◽  
Trauma Patients ◽  
Soft Tissue Defects ◽  
Cutaneous Flap ◽  
Tissue Defects

Introduction. Soft tissue defects in the distal leg and foot are challenging conditions for reconstruction. The widely used reverse sural fascio-cutaneous flap (RSFCF) has been reported with large variation in complication frequency. Some authors reported higher complications in the diabetic population when compared with trauma patients. We compared the reliability of the RSFCF in treating such defects among both populations. Methods. This is a retrospective series with a prospective data collection of 24 patients (11 with type 2 diabetes and 13 in trauma settings) treated with an ipsilateral RSFCF for soft tissue defects of the distal leg and the rear foot. Healing events and complications were recorded and compared for both groups. The mean follow-up was 32 months. Results. Diabetic group versus trauma group showed the following results; mean flap healing time of 24 versus 22 days, donor site healing time of 14 versus 16 days, 1 total flap necrosis in both groups, 3 versus 2 cases of skin edge necrosis, 2 cases of temporary venous congestion in both groups, and 8 versus 10 cases of transient hypoesthesia of the lateral border of the foot. No infection was encountered in both groups and no recurrence of infection in the primary infected diabetic patients. Conclusions. We found the RSFCF to be useful, reproducible, and reliable in treating soft tissue defects with a very low frequency of serious complications. Diabetic patients were found to have similar outcomes when compared with trauma patients. Therefore, diabetes might not be a major factor of flap failure. Levels of Evidence: Level III: Therapeutic

scholarly journals Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

2017 ◽  
Vol 45 (3) ◽  
pp. 1074-1089 ◽  
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.

Preliminary Experience with Perforator Flaps in Reconstruction of Soft-Tissue Defects of the Foot and Ankle

2005 ◽  
Vol 26 (3) ◽  
pp. 191-197 ◽  
Author(s):  
Frederick J. Duffy ◽  
James W. Brodsky ◽  
Christian T. Royer
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Foot And Ankle ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Microsurgical Reconstruction ◽  
Tissue Defects

Background: Microsurgical reconstruction has improved limb salvage in patients who because of many etiologies have soft-tissue loss from the lower extremities. Free-tissue transfer to the foot and ankle often interferes with postoperative function and footwear because of the bulk of a muscle flap. The foot and ankle often are best treated using thin flaps that will not contract and fibrose, particularly if secondary procedures are required. We hypothesized that perforator flaps, which are thin free-tissue transfers consisting of skin and subcutaneous tissue, both diminish donor site morbidity and are ideally suited for soft-tissue reconstruction of the foot and ankle. Methods: Ten patients had free- tissue transfers to the foot and ankle using perforator flaps during a 2-year period. Four had acute posttraumatic wounds, three had soft tissue defects with exposed hardware or bone graft after reconstructive surgery, and three had large soft-tissue defects after foot infection secondary to diabetes. Nine had reconstruction with anterolateral thigh perforator flaps and one had reconstruction with a deep inferior epigastric artery (DIEP) perforator flap. Results: All flaps survived. There were no deep infections. Three flaps had minor tissue loss requiring subsequent small skin grafts, all of which healed. There were no donor site complications and no interference of muscle function at the donor sites. Custom shoewear was not required to accommodate the flaps. Conclusion: This series highlights the success and utility of perforator flaps in microsurgical reconstruction of the foot and ankle. The greatest advantage of perforator flaps is the diminished donor site morbidity, which was achieved while maintaining high microsurgical success rates. These skin and fat flaps remained pliable and contracted less than muscle flaps, allowing for smooth tendon gliding and easy flap elevation for secondary orthopaedic procedures.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals Free Thoracodorsal Artery Polyfoliate Perforator Flaps for Repairing Multiple Soft Tissue Defects in the Hand

2021 ◽  
Author(s):  
Wenquan Ding ◽  
Jianbo Xue ◽  
Yingling Zhou ◽  
Lingfeng He ◽  
Xiaofeng Wang
Keyword(s):  
Soft Tissue ◽  
Evaluation System ◽  
Operative Time ◽  
Donor Site ◽  
Active Movement ◽  
Soft Tissue Defects ◽  
Perforator Flaps ◽  
Short Operative Time ◽  
Thoracodorsal Artery ◽  
Tissue Defects

Abstract Background: Hand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.To confirm the feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand. Methods: Fifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated. Results: The flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12-26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Obvious scar hyperplasia was noted in three patients. A puffed appearance in the recipient area was noted in four patients.To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs. Conclusion: Free thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

scholarly journals Functional and aesthetic outcomes of first dorsal metacarpal artery flap for thumb reconstruction: a prospective study

2020 ◽  
Vol 7 (7) ◽  
pp. 2268
Author(s):  
Sujana Ravada ◽  
Surya Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Sensory Function ◽  
Soft Tissue Defects ◽  
Aesthetic Outcome ◽  
Dorsal Metacarpal Artery ◽  
The Mean ◽  
The Aesthetic ◽  
Tissue Defects ◽  
First Dorsal Metacarpal Artery

Background: Reconstruction of soft tissue defects of the thumb, with exposure of tendon, joint or bone, has been a challenging problem. Surgical options include local, regional or free flaps. Here, we have evaluated the functional and aesthetic outcomes of first dorsal metacarpal artery (FDMA) island flap in reconstruction of various soft tissue defects of the thumb.Methods: Between January 2018 and January 2019, twenty patients with post-traumatic and post-infective thumb defects underwent FDMA flaps. Sensory function was evaluated with static 2 point discrimination and mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was also assessed.Results: The mean defect size was 39.9×19.95 mm. Eighteen flaps survived completely and one had distal flap necrosis and one had superficial epidermal peeling which was treated conservatively. The mean static two-point discrimination was 9.3 mm. Cortical reorientation was complete in 45%. The average Kapandji score was 7.9. The aesthetic outcome was excellent in ten, good in eight and poor in two subjects. After a mean follow up period of 11.85 months, most patients regained all functions of the thumb and index finger and were pleased with the cosmetic appearance of the flap and donor site.Conclusions: FDMA flap offers a good quality skin cover for small to moderate sized thumb defects. It is a reliable and versatile flap which is sensate and pliable. It gives excellent functional and aesthetic outcomes with minimal or no donor site morbidity.

Reverse Sural Fascio-Cutaneous Flap for Management of Patients with Distal Third of Lower Limb Soft Tissue Defects Referring to the Emergency Department Following Traumatic Events; A Review of 13 Cases

2021 ◽  
Author(s):  
Hosseinali Abdorrazzaghi ◽  
Babak Hajibarati ◽  
Fateme Mohammadi
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Lower Limb ◽  
Daily Life ◽  
Case Series ◽  
Lower Limbs ◽  
Soft Tissue Defects ◽  
Daily Life Activities ◽  
Cutaneous Flap ◽  
Tissue Defects

Introduction: Soft tissue defects over the distal leg and/or heel are probable injuries that need a flap. Various coverage techniques have been described in this regard. It seems that applying Reverse Sural Fascio-Cutaneous Flap (RSFCF) for reconstructing soft tissue defects of lower limbs has superiorities over other techniques. Objective: We intend to present a case series with soft tissue defect over the distal third of lower limb, covered using RSFCF technique.   Methods: This is a case series and longitudinal study in which patients with crush injuries who referred to the emergency department (Sina hospital, Tehran, Iran) from 2013 until 2020 and were treated with RSFCF technique were included. The data were collected using patients’ charts, by interviewing the patients, and from hospital records. The patients' wounds were prepared, examined, and the surgery was done. Tendon and bone defects were repaired, and wounds were closed using reverse sural Fascio-Cutaneous Flap. Results: A total of 13 patients were eligible during the 6-year study period. Men were more commonly affected with no conclusive gender trend. The posterolateral part of the foot of the right leg was the most frequently injured part (53.8%). Only 1 patient had mentioned complications after surgery including mild congestion and abnormal sensory and motor examination. Patients were followed by the surgeons until 3 months after the operation and all of them had been able to resume their daily life activities by then. Conclusion: According to our findings, almost all of the patients (except one) had received their flaps without any complications. All the patients had been able to resume their daily life activities three months after the surgery. This may show that RSFCF, which can be quickly performed and does not need microsurgical skills, could be a suitable option for the coverage of distal third of lower limb soft tissue defects caused mainly by trauma

scholarly journals EVALUATION OF THE REVERSE SURALARTERY FLAP IN THE PAEDIATRIC AGE GROUP

2020 ◽  
pp. 1-3
Author(s):  
Macnol Afonso
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Group Method ◽  
Age Group ◽  
Soft Tissue Defects ◽  
Loss Of Function ◽  
No Donor ◽  
Paediatric Age ◽  
Sural Artery ◽  
Tissue Defects

Introduction: The Reverse sural artery flap can be used to cover soft tissue defects of the distal leg, ankle and proximal foot. The flap has rarely been evaluated in the paediatric age group. Method: A Retrospective study was undertaken including four children, with soft tissue defects of the distal leg and foot covered using a distally based Reverse sural artery flap. Results: All flaps survived (100%). Venous congestion did not occur in any patient. Marginal flap necrosis occurred in one patient (25%). Reinsetting of the flap was done in one patient (25%). There was no donor site morbidity. Conclusions: The reverse sural artery flap can be easily raised, while sparing the major blood vessels and without any major loss of function. As such it can be reliably used to cover defects of the distal leg and foot in the paediatric age group

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