scholarly journals The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique

2020 ◽  
Author(s):  
Yu-bo Zhang ◽  
Yuan-jian Wu ◽  
Wen-jun Zhang ◽  
Tao Zhang ◽  
Tengfei Lou ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Distraction Osteogenesis ◽  
Perforator Flap ◽  
Bone Defects ◽  
Soft Tissue Coverage ◽  
Segmental Defect ◽  
Tissue Defect ◽  
Neurovascular Flap ◽  
Tract Infections

Abstract Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57) at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm.Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.Trial registration: This article has been retrospectively registered.

scholarly journals The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique.

2020 ◽  
Author(s):  
Yuan-jian Wu ◽  
Yu-bo Zhang ◽  
Wen-jun Zhang ◽  
Tao Zhang ◽  
Tengfei Lou ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Distraction Osteogenesis ◽  
Perforator Flap ◽  
Bone Defects ◽  
Soft Tissue Coverage ◽  
Segmental Defect ◽  
Tissue Defect ◽  
Neurovascular Flap ◽  
Tract Infections

Abstract Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method. Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57)at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm. Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection. Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.

scholarly journals The role of perforating artery pedicled neurotrophic flap in the treatment of compound tissue defect of tibia with Ilizarov technique

2020 ◽  
Author(s):  
Yu-bo Zhang ◽  
Yuan-jian Wu ◽  
Wen-jun Zhang ◽  
Tao Zhang ◽  
Tengfei Lou ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Distraction Osteogenesis ◽  
Perforator Flap ◽  
Bone Defects ◽  
Soft Tissue Coverage ◽  
Segmental Defect ◽  
Tissue Defect ◽  
Neurovascular Flap ◽  
Tract Infections

Abstract Background The aim of this research is to present our experience with the combined use of pedicled neurotrophic flap and distraction osteogenesis in management of complex lower extremity injuries with composite bone and soft tissue defects and assess the functional and cosmetic results of this method.Methods Between 2008 and 2016, soft tissue coverage with pedicled neurotrophic flap followed by distraction osteogenesis using Ilizarov external fixator was performed in 25 patients for reconstruction of segmental bone defects of lower extremity complicated by massive loss of soft tissue. There were 16 men and 9 women: their mean age was 39 years (23 to 57) at the time of surgery. The soft tissue defect after radical debridement ranged from 5 × 9 cm2 to 11 × 14 cm2, and the average size of segmental defect was 5.02 (2.5 to 7.5) cm.Results The distally based sural neurovascular flap was performed in 13 patients, and the greater saphenous neurocutaneous perforator flap in 12 patients. All flaps survived completely without complications. The bone defects were corrected by a mean lengthening of 6.74 (4.5 to 9.5) cm. The function was judged to be excellent in 12 patients and good in 13 patients. Bone results were graded as excellent in 18 patients and good in 7 patients. Complications observed in the process of the treatment included pain, pin tract infections (PTI), ankle midfoot joints stiffness, and nonunion of docking sites. All the cases achieved successful limb salvage and satisfactory function recovery without recurrence of infection.Conclusions The combined technique of a perforator artery pedicled neurotrophic flap and distraction osteogenesis should be considered to be an effective alternative approach in the salvage treatment of the massively traumatized and chronically infected lower extremity.

Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the ventral thoracic wall

2007 ◽  
Vol 30 (3) ◽  
pp. 141-146 ◽  
Author(s):  
S. Deiler ◽  
R. Zulkowski ◽  
O. Muensterer ◽  
J. Widmann ◽  
K. G. Kanz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Soft Tissue Defect ◽  
Thoracic Wall ◽  
Tissue Defect

scholarly journals Double-Pedicled Free Deep Inferior Epigastric Perforator Flap for the Coverage of Thigh Soft-Tissue Defect

2017 ◽  
Vol 5 (8) ◽  
pp. e1372 ◽  
Author(s):  
Olimpiu Bota ◽  
Nick Spindler ◽  
Jeannine Sauber ◽  
Emrah Aydogan ◽  
Stefan Langer
Keyword(s):  
Soft Tissue ◽  
Perforator Flap ◽  
Soft Tissue Defect ◽  
Tissue Defect ◽  
Deep Inferior Epigastric Perforator

A Review of Local Soft Tissue Coverage Options for Oncologic Defects of the Distal Lower Extremity

2020 ◽  
Vol 30 (2) ◽  
pp. 100802
Author(s):  
Leigh J. Spera ◽  
Rachel M. Danforth ◽  
Eric Pittelkow ◽  
Ivan Hadad
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Soft Tissue Coverage

scholarly journals Microsurgical Reconstruction of the Lower Extremity

2019 ◽  
Vol 33 (01) ◽  
pp. 054-058 ◽  
Author(s):  
Luke Grome ◽  
William Pederson
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Donor Site ◽  
Foot Drop ◽  
Long Term Results ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Coverage ◽  
Soft Tissue Reconstruction ◽  
Muscle Flaps ◽  
Microsurgical Reconstruction

AbstractReconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.

Free versus Pedicled Perforator Flaps for Lower Extremity Reconstruction: A Multicenter Comparison of Institutional Practices and Outcomes

2018 ◽  
Vol 34 (08) ◽  
pp. 572-580 ◽  
Author(s):  
Keith Koh ◽  
Terence Goh ◽  
Christopher Song ◽  
Hyun Suh ◽  
Peter Rovito ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Soft Tissues ◽  
Perforator Flap ◽  
Free Flaps ◽  
Careful Consideration ◽  
Pedicled Flap ◽  
Perforator Flaps ◽  
Body Regions ◽  
Significant Difference

Background Of all body regions, lower extremity wounds have been and remain the greatest challenge. Perforator free flaps have been accepted as a reasonable option to solve this dilemma but require the complexity of microsurgery. As a consequence, the possibility that pedicled perforator flaps could supplant even perforator free flaps has recently gained intense enthusiasm. Methods A retrospective investigation was undertaken to compare the validity for the use of perforator flaps of all types at three dissimilar institutions, that is, a university, a regional center, and a community hospital. All flaps performed in the 5-year period, 2011 to 2015, were included to allow at least 1-year follow-up before data analysis. A total of 433 free perforator flaps and 52 pedicled perforator flaps had been performed specifically for the lower extremity. Results Patient demographics, wound etiology, and comorbidities were similar for all institutions. Free flaps were more commonly needed after trauma and for chronic ulcers. Pedicled flaps were more likely an option after tumor excision. Large defects or those involving the foot were better served by free flaps. Overall success for free perforator flaps was 90.1% and for pedicled perforator flaps was 92.3%, with no significant difference noted (p = 0.606) between institutions. Peripheral vascular disease was the only significant comorbidity risk factor for both free and pedicled flap failure. Conclusion Perforator flaps in general have become a reasonable solution for soft tissue defects of the lower extremity. Following careful consideration of the etiology, dimensions, location, patient comorbidities, and presence of adequate perforators, a pedicled or free perforator flap could potentially be successful. Pedicled perforator flaps, if adequate healthy soft tissues remain adjacent to the defect, forecast a continuance of the evolution in seeking simplicity yet reliability by the best flap possible for soft tissue closure of the lower limb wound.

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