scholarly journals Intraadiposal Pedicle Dissection when Performing Free Tissue Transfer: A Means to Address a Short Pedicle

2021 ◽  
Vol 17 (2) ◽  
pp. 141-145
Author(s):  
Jung Han Lim ◽  
Jung Woo Chang

A 77-year-old male patient with a diabetic foot ulcer on his right great toe visited the outpatient clinic. As necrosis of the toe had already progressed, the patient underwent toe amputation to prevent extensive gangrene. With the goal of enabling future ambulation, an anterolateral thigh fasciocutaneous free flap was planned to preserve the metatarsal head and to cover the defect. Subfascial dissection was performed when elevating the fasciocutaneous flap, but the sole healthy perforator was in an extremely proximal area and allowed only a 4-cm-long pedicle. The pedicle had to be at least 8 cm long to ensure secure anastomosis to the medial plantar artery. To overcome this unexpected challenge, we pierced the deep fascia near the perforator and dissected the perforator distally within the deep adipose layer. The necessary additional length of the pedicle was obtained through intraadiposal dissection. The flap survived without any complications, and the foot was reconstructed with successful ambulation. This case demonstrates the value of attempting intraadiposal pedicle dissection when the pedicle turns out to be unmanageably short.


2018 ◽  
Vol 14 (2) ◽  
pp. 68-73
Author(s):  
Sooseong Leem ◽  
Jung Woo Chang ◽  
M. Seung Suk Choi


Masker Medika ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 163-175
Author(s):  
Sukron Sukron

Latar Belakang : Meningkatnya angka penyakit diabetes melitus tipe 2 khususnya di Indonesia bersamaan dengan meningkatnya komplikasi salah satunya diabetic foot ulcer yang juga merupakan faktor terjadinya gangguan sensitivitas pada kaki. Pencegahan dapat dilakukan dengan mengukur sensitivitas kaki dengan menggunkan monofilmen test. Tujuan Penelitian : Untuk mengetahui gambaran tingkat sensitivitas kaki pada penderita diabetes melitus tipe 2 di Rumah Sakit Muhammadiyah Palembang. Metode Penelitian : Penelitian ini merupakan penelitian dengan metode Deskripti Analitik dengan pendekatan kuantitatif. Teknik sampling menggunakan convenience sampling pada pasien diabetes melitus tipe 2 di Rumah Sakit Muhammadiyah Palembang yang berjumlah 60 responden. Hasil : Hasil penelitian menunjukkan bahwa rata-rata pasien diabetes melitus tipe 2 berusia 59,45 tahun dan sebagaian besar berjenis kelamin laki-laki dengan tingkat pendidikan sebesar 33,3% SD dan 33,3% SMA. Rerata responden juga menderita diabetes melitus tipe 2 selama 3,58 tahun dengan sebagian besar responden tidak berkerja dan tidak berolahraga. Serta tingkat sensitivitas kaki pada pasien diabetes melitus tipe 2yang tidak ada rasa dengan frekuensi tertinggi yaitu pada dorsal kaki sebanyak 25 orang (41,67%), metatarsal head ke-1 sebanyak 23 orang (38,33%), Midfoot bagian Medial sebanyak 22 orang (36,67), jari tengah sebnayk 21 orang (35%), metatarsal head ke-3 sebanyak 20 orang (33,33%), Midfoot bagian lateral sebanyak 20 orang (33,33%), Tumit sebanyak 18 orang (30%), jari kelingking sebanyak 18 orang (30%), metatarsal haed ke-2 sebanyak 17 orang (28,33%), dan terendah yaitu padajempol kaki dengan frekuensi 12 responden (20%). Kesimpulan : sensitivitas kaki pada pasien diabetes melitus tipe II yaitu terendah pada dorsal kaki.   Background: The increasing number of type II diabetes mellitus, especially in Indonesia together with the increase in complications, one of which is diabetic foot ulcer, which is also a factor in sensitivity to the feet. Prevention can be done by measuring foot sensitivity by using a monofilment test. Objective: To find out the description of the level of sensitivity of the foot in patients with type II diabetes mellitus patients in Muhammadiyah Hospital Palembang. Method of Researvh: This research is a research with Analytic Descriptive method with quantitative approach. The sampling technique uses convenience sampling in patients with type II diabetes mellitus at Muhammadiyah Hospital Palembang, amounting to 60 respondents. Result of Research: The results showed that the average type II diabetes mellitus patients were 59.45 years old and most were male with education level of 33.3% elementary school and 33.3% high school. The average respondent also suffered from type II diabetes mellitus for 3.58 years with most respondents not working and not exercising. And the level of sensitivity of the foot in patients with type II diabetes mellitus that does not have the highest frequency is the dorsal foot of 25 people (41.67%), the first metatarsal head of 23 people (38.33%), Midfoot of the Medial section of 22 people (36.67), middle fingers 21 people (35%), 3rd metatarsal head as many as 20 people (33.33%), lateral midfoot as many as 20 people (33.33%), Heel as many as 18 people ( 30%), the pinky finger was 18 people (30%), the second metatarsal haed were 17 people (28.33%), and the lowest was the big toe with a frequency of 12 respondents (20%). Conclusion: Foot sensitivity in type II diabetes mellitus patients is lowest in the dorsal foot.



2019 ◽  
Author(s):  
Jenna C. Bekeny ◽  
Vikas S. Kotha ◽  
Elizabeth G. Zolper ◽  
Christopher J. Kennedy ◽  
Jonathan Day ◽  
...  

Historically, patients with chronic diabetic foot ulcers were managed with major lower extremity amputations such as below-knee amputations and above-knee amputations. With the advancement of microsurgical techniques, patients have been able to achieve limb salvage and reap the associated morbidity and mortality benefits. In order to ensure successful limb salvage, a patient’s biomechanic, diabetic, vascular, and infectious profiles need to be optimized. Serial debridement supplemented with antibiotics until negative deep tissue cultures is the gold standard for infection eradication. A surgeon needs to have a good understanding of patient and wound-specific anatomic considerations. Simpler techniques, such as primary closure, skin grafting, and Integra placement, may be used.  In complex wounds, more involved reconstructive modalities, such as local flap or free tissue transfer, may be required. Coverage selection depends on an intimate understanding of the patient’s comorbidities, wound characteristics, and vascular status. This review contains 7 figures, 2 tables, and 32 references. Keywords: diabetic foot ulcer, chronic wound, nonhealing vasculopathic wound, local flap, free flap, free tissue transfer, abductor digiti minimi flap, abductor hallicus flap, flexor digitorum brevis flap





Author(s):  
Dr. Devi Das Verma ◽  
Dr. Anil Kumar Saxena

Introduction:  Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries.  From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia.  Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer.  Material and method:  Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included.  From all the patients’ detailed past and present history were recorded.  For all the patients, general, physical and local and systemic examinations were also done. Detail   laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation. Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old.  6.7% showed the least age group as 20 -30 years old.  Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot.  Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers.  Hence, foot infection is to put first and care for it like hands. Keywords: Diabetes, foot ulcers, infections, amputations.



2015 ◽  
Author(s):  
Fakhraddeen Muhammad ◽  
Lateefah Pedro ◽  
Hassan Suleiman ◽  
Enikuomehin Adenike ◽  
Rahila Mukhtar ◽  
...  


2019 ◽  
Author(s):  
Maksym Prystupiuk ◽  
Iuliia Onofriichuk ◽  
Lev Prystupiuk ◽  
Ludmila Naumova ◽  
Marianna Naumova


Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 603-P
Author(s):  
LEWIS FREED


Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2155-PUB
Author(s):  
JEEHEE KIM


2017 ◽  
Vol 1 (1) ◽  
pp. 59-63
Author(s):  
Palamalai Dinakaran ◽  


Sign in / Sign up

Export Citation Format

Share Document