scholarly journals Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Peng Wang ◽  
Fang Lin ◽  
Yunhong Ma ◽  
Jianbing Wang ◽  
Ming Zhou ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Free Tissue Transfer ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Safe Distance ◽  
Defect Location ◽  
Propeller Flap ◽  
Tissue Transfer ◽  
Shortest Distance

Abstract Background Soft tissue defects in the distal third of the leg and malleolus are difficult to cover and often require free tissue transfer, even for small-sized defects. Propeller flaps were designed as an alternative to free tissue transfer, but are reportedly associated with high complication rates. The aim of our study was to assess our institutional experience with the propeller flap technique and to predict its outcome in lower-limb reconstruction. Methods All patients who had undergone propeller flap reconstruction of a distal leg defect between 2013 and 2018 were included. Demographic, clinical, and follow-up data were analyzed. Results Complications occurred in 17 of 82 propeller flaps (20.7%), comprising 11 cases of partial necrosis and six of total necrosis. There were no significant differences in age, sex, body mass index smoking, diabetes mellitus, and soft tissue defect sites between the groups of patients with versus without flap necrosis (p > 0.05). In univariate analysis, there were also no significant differences between these two groups in the length and width of the fascial pedicle, and the ratio of the flap length to the flap width (p > 0.05). Interestingly, there were significant differences between the two groups in the distance between the flap perforator, the shortest distance from the perforator to the defect location, and the rotation angle of the flap (p < 0.05). In multivariable logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (95% CIs), the shortest distance from the perforator to the defect location was a significant risk factor for flap complications (p = 0.000; OR = 0.806). Receiver operating characteristic curve analysis showed that when the shortest distance from the flap to the wound was less than 3.5 cm, the necrosis rate of the flap was markedly increased (AUC = 76.1); this suggests that the effective safe flap–wound distance was 3.5 cm. Conclusions Propeller flaps are a reliable option for reconstruction in carefully selected patients with traumatic defects of the lower limb and malleolus. We found that the effective safe distance was 3.5 cm from the flap to the wound.

scholarly journals Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge

2021 ◽  
Author(s):  
Peng Wang ◽  
Fang Lin ◽  
YunHong Ma ◽  
Jianbing Wang ◽  
Ming Zhou ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Safe Distance ◽  
Propeller Flap ◽  
Tissue Transfer ◽  
Defect Sites

Abstract Introduction: Soft tissue defects in the distal third of the leg and malleolus are difficult to cover and often require free tissue transfer, even for small-sized defects. Propeller flaps were designed as an alternative to free tissue transfer, but are reportedly associated with high complication rates. The aim of our study was to assess our institutional experience with the propeller flap technique and to predict its role in lower-limb reconstruction. Methods: All patients who had undergone propeller flap reconstruction of a distal leg defect between 2013 and 2018 were included. Demographic, clinical, and follow-up data were analyzed. Results: Complications occurred in 17 of 82 propeller flaps (20.7%), comprising 11 cases of partial necrosis and six of total necrosis. There were no significant differences in age, sex, body mass index smoking, diabetes mellitus, and soft tissue defect sites between the groups of patients with versus without flap necrosis (p > 0.05). In the multivariable logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (95% CIs), there were also no significant differences between these two groups in the length and width of the fascial pedicle, and the ratio of the flap length to the flap width (p > 0.05). Interestingly, there were significant differences between the two groups in the distance between the flap perforator and the wound center (p < 0.05) and the rotation angle of the flap (p < 0.05). Receiver operating characteristic curve analysis showed that when the nearest distance from the flap to the wound was less than 3.5 cm, the necrosis rate of the flap was markedly increased (AUC = 76.1); this suggests that the effective safe flap–wound distance was 3.5 cm. Conclusions: Propeller flaps are a reliable option for reconstruction in carefully selected patients with traumatic defects of the lower limb and malleolus. What we found is that What we found is that the ‘effective safe distance’ was 3.5 cm which the distance from the flap to the wound.

scholarly journals Reconstructive Treatment following Resection of High-Grade Soft-Tissue Sarcomas of the Lower Limb

2005 ◽  
Vol 13 (1) ◽  
pp. 58-63 ◽  
Author(s):  
AM Leow ◽  
AS Halim ◽  
Z Wan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Soft Tissue Sarcomas ◽  
Free Tissue Transfer ◽  
Rectus Abdominis ◽  
Lower Limbs ◽  
High Grade ◽  
Rectus Abdominis Flap ◽  
Tissue Transfer ◽  
Fibula Flap

Purpose. To review the role of free tissue transfer in reconstructive surgery following resection of high-grade soft-tissue sarcomas of the lower limb. Methods. Medical records of all consecutive patients with high-grade soft-tissue sarcomas of the lower limbs between August 1997 and September 2003 were reviewed. Results. Of 8 patients (6 women and 2 men) aged between 19 and 65 years, 4 had malignant fibrous histiocytoma, one had malignant peripheral nerve sheath tumour, one had synovial sarcoma, one had recurrent liposarcoma, and one had epitheloid sarcoma. The tumour sizes ranged from 132 cm2 to 483 cm2. The soft-tissue defects following tumour extirpation ranged from 153 cm2 to 896 cm2. The flaps used were 3 free latissimus dorsi flaps, 2 free osteoseptocutaneous fibula flaps (one vascularised fibula flap and one ‘double barrel’ fibula flap), one free rectus abdominis flap, 2 free mini-transverse rectus abdominis flaps, and one pedicled rectus abdominis flap. Five patients did not have local recurrence and systemic metastases. Conclusion. Tissue transfer allows early adjuvant therapy facilitating the multimodal approach for the high-grade soft-tissue sarcomas of the lower extremity.

scholarly journals Maximizing Outcomes While Minimizing Morbidity: An Illustrated Case Review of Elbow Soft Tissue Reconstruction

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Adrian Ooi ◽  
Jonathan Ng ◽  
Christopher Chui ◽  
Terence Goh ◽  
Bien Keem Tan
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Case Review ◽  
Tissue Transfer ◽  
Tissue Reconstruction ◽  
Elbow Reconstruction

Background. Injuries to the elbow have led to consequences varying from significant limitation in function to loss of the entire upper limb. Soft tissue reconstruction with durable and pliable coverage balanced with the ability to mobilize the joint early to optimize rehabilitation outcomes is paramount. Methods. Methods of flap reconstruction have evolved from local and pedicled flaps to perforator-based flaps and free tissue transfer. Here we performed a review of 20 patients who have undergone flap reconstruction of the elbow at our institution. Discussion. 20 consecutive patients were identified and included in this study. Flap types include local (n=5), regional pedicled (n=7), and free (n=8) flaps. The average size of defect was 138 cm2 (range 36–420 cm2). There were no flap failures in our series, and, at follow-up, the average range of movement of elbow flexion was 100°. Results. While the pedicled latissimus dorsi flap is the workhorse for elbow soft tissue coverage, advancements in microvascular knowledge and surgery have brought about great benefit, with the use of perforator flaps and free tissue transfer for wound coverage. Conclusion. We present here our case series on elbow reconstruction and an abbreviated algorithm on flap choice, highlighting our decision making process in the selection of safe flap choice for soft tissue elbow reconstruction.

scholarly journals Free Tissue Transfer in Pediatric Lower Limb Trauma

2019 ◽  
Vol 52 (01) ◽  
pp. 037-044 ◽  
Author(s):  
R. Srikanth
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Large Series ◽  
Soft Tissue Coverage ◽  
Wound Coverage ◽  
Tissue Transfer ◽  
Limb Trauma ◽  
Lower Limb Trauma

AbstractFree tissue transfer has become the standard in wound coverage and further refinements have given us newer flap donor sites or modifications of existing flaps to decrease morbidity; smaller vessels are being anastomosed, a direct spin-off following successful distal replantations. Younger children are presenting with traumatic defects similar to adults. Although there were apprehensions of free tissue transfer in children occasioned by smaller vessels, duration of procedure and concerns of growth following flap harvest, reports of small and large series have appeared in the literature with similar success. Pediatric-free tissue transfer is now an established entity. This article seeks to arrive at a consensus based on a review of the existing literature on free flaps for skin and soft-tissue coverage of lower limb trauma in children.

Pediatric Microsurgery in the Reconstruction of Complex Posttraumatic Foot and Ankle Defects: A Long-Term Follow-Up with a Comprehensive Review of the Literature

2020 ◽  
Author(s):  
Amr Elbatawy ◽  
Mohammed Elgammal ◽  
Tarek Zayid ◽  
Abdelnaser Hamdy ◽  
Mohamed Osama Ouf ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Adult Population ◽  
Free Tissue Transfer ◽  
Anterior Tibial Artery ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Review Of The Literature ◽  
Tissue Transfer

Abstract Background Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. Methods We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. Results Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. Conclusion The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.

Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation

2018 ◽  
Vol 35 (04) ◽  
pp. 287-293 ◽  
Author(s):  
Rohini Kadle ◽  
Catherine Motosko ◽  
George Zakhem ◽  
John Stranix ◽  
Timothy Rapp ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Radiation Treatment ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Fasciocutaneous Flaps ◽  
Musculoskeletal Tumor Society

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]). Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.

scholarly journals Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

2019 ◽  
Vol 7 (3) ◽  
pp. 866
Author(s):  
Bhushan R. Patil ◽  
Chandrashekhar Wahegaonkar ◽  
Nikhil Agarkhedkar ◽  
Bharat Bhushan Dogra
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Free Tissue Transfer ◽  
Soft Tissue Defects ◽  
Pedicle Flap ◽  
Tissue Transfer ◽  
Major Vessel ◽  
Sural Artery ◽  
Tissue Defects ◽  
Ankle And Foot

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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