Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue reconstruction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

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Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02479-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhao Yang ◽

Chao Xu ◽

Yong-Gang Zhu ◽

Jun Li ◽

Zi-Xiang Wu ◽

...

Keyword(s):

Soft Tissue ◽

Infection Rate ◽

Clinical Data ◽

Open Fractures ◽

Soft Tissue Reconstruction ◽

Satisfactory Outcome ◽

Tissue Damages ◽

Tissue Reconstruction ◽

Severe Soft Tissue

Abstract Objective This study aimed to retrospectively analyze clinical data of a series of patients with severe open fractures of extremities (Gustilo IIIb or IIIc), who achieved a satisfactory outcome through radical orthoplastic surgery, so as to provide a reference for determining the treatment of severe open fractures of extremities. Methods The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and January 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. Results The mean (±SD) age of the patients was 38 ± 16 years. A total of 90 open fractures and severe soft tissue damages were analyzed. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. Conclusion The overall rate of infection exhibited a lower tendency in this study compared with previous studies on high-grade open fractures following a two-stage orthopedic approach. The consequence of infection rate and union time was similar to that in previous studies. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

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Utilizing a Crossover Reverse Sural Artery Flap for Soft Tissue Reconstruction of the Plantar Forefoot After a Severe Degloving Injury

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734606298166 ◽

2007 ◽

Vol 6 (2) ◽

pp. 114-119 ◽

Cited By ~ 12

Author(s):

Thomas Zgonis ◽

Douglas T. Cromack ◽

John J. Stapleton

Keyword(s):

Soft Tissue ◽

Soft Tissue Reconstruction ◽

Degloving Injury ◽

Tissue Reconstruction ◽

Sural Artery

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Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001610010364 ◽

2016 ◽

Vol 10 (1) ◽

pp. 364-374

Author(s):

P.A. Ivanov ◽

E.U. Shibaev ◽

A.V. Nevedrov ◽

A.P. Vlasov ◽

M.P. Lasarev

Keyword(s):

Soft Tissue ◽

Soft Tissues ◽

Soft Tissue Defect ◽

Control Group ◽

Soft Tissue Reconstruction ◽

Infection Frequency ◽

Treatment Results ◽

Tissue Defect ◽

Tissue Reconstruction ◽

Tibia Fractures

Introduction: Tactic of emergency closing of soft tissue defect allows to significantly improve the treatment results concerning patients with severe open fractures. However, a number of certain factors make the implementation of this tactic rather difficult. Injured people’s unstable conditions are mong these crucial factors which include, polytrauma in lots of cases, absence of exact recommendations for recovery terms, choice of definite tissue flaps and a type of circulation. The Aim of Study: is to develop exact, usable and in practice algorithm of emergency reconstruction of leg soft tissues in patients with severe open tibia fractures, based on the usage of the most foolproof and simple methods. Data (Patients) and Methods: 85 patients with open tibia fractures complicated by soft tissue defects were included in our study. Patients were divided into two groups. The control group consisted of 56 patients. Soft tissue reconstruction in this group was provided without an exact algorithm, after continuous attempts on local healing. After analyzing the treatment process and the treatment results we have developed the algorithm of emergency soft tissue reconstruction. It was used in 29 patients (the study group). This algorithm allows choosing optimal timing for tissue reconstruction and appropriate method to be applied, depending on the patient’s condition, the mechanism of soft tissue defect formation, and its square and localization. Results: We observed a statistical decrease in deep wound infection frequency, partial tibia necrosis frequency, chronic osteomyelitis frequency, duration of hospitalization in patients with severe open tibia fractures because of using our algorithm.

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Distally Based Sural Faciocutaneous and Fascial (Adipofascial) Flap for Reconstruction of Distal Leg, Ankle and Foot Defects

Kathmandu University Medical Journal ◽

10.3126/kumj.v12i2.13659 ◽

2015 ◽

Vol 12 (2) ◽

pp. 126-131 ◽

Cited By ~ 2

Author(s):

NP Parajuli ◽

D Shrestha ◽

N Panse

Keyword(s):

Soft Tissue ◽

Secondary Infection ◽

Soft Tissue Defect ◽

Soft Tissue Reconstruction ◽

Sural Flap ◽

Hind Foot ◽

Sural Artery ◽

Distally Based ◽

Distally Based Sural Flap ◽

Ankle And Foot

Background Any soft tissue defect in distal leg, ankle and hind foot is still a challenging problem. There are various options for coverage of such defects, but the distally based sural neurocutaneous and neurofascial flap based on the sural nerve and superficial sural artery has been an important option.Objective To evaluate the efficacy of distally based sural flap in reconstruction of the distal leg, ankle and hind foot soft tissue defects.Method Seventeen patients with soft tissue defects over distal leg, ankle and hind foot were included in this study. All patients were treated with distally based sural flap. Most of the cases were due to trauma (16 cases) which compromised tendon and bone. One case was of malignant melanoma of sole of hind foot which required wide excision and soft tissue reconstruction with sural flap.Result In all cases defects were successfully covered. Three showed venous congestion and partial necrosis. One developed secondary infection. One flap failed completely. Mean follow up of patients was 20 months (6 – 36 months).Conclusion Sural flap is a good option for reconstruction of distal leg, ankle and foot defects.Kathmandu University Medical Journal Vol.12(2) 2014: 126-131

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Vascular Perfusion of a Flexor Carpi Ulnaris Muscle Turnover Pedicle Flap for Posterior Elbow Soft Tissue Reconstruction: A Cadaveric Study

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2010.10.035 ◽

2011 ◽

Vol 36 (2) ◽

pp. 246-251 ◽

Cited By ~ 15

Author(s):

Diane E.S. Payne ◽

Adam M. Kaufman ◽

Robert W. Wysocki ◽

Marc J. Richard ◽

David S. Ruch ◽

...

Keyword(s):

Soft Tissue ◽

Cadaveric Study ◽

Soft Tissue Reconstruction ◽

Vascular Perfusion ◽

Pedicle Flap ◽

Flexor Carpi Ulnaris ◽

Tissue Reconstruction

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Soft-tissue coverage for wound complications following total elbow arthroplasty

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00409 ◽

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.

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Flexor Carpi Ulnaris Muscle Flap for Soft Tissue Reconstruction after Total Elbow Arthroplasty

Case Reports in Surgery ◽

10.1155/2014/798506 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Syunro Okamoto ◽

Kaoru Tada ◽

Hachinota Ai ◽

Hiroyuki Tsuchiya

Keyword(s):

Soft Tissue ◽

Muscle Flap ◽

Clinical Results ◽

Soft Tissue Defect ◽

Total Elbow Arthroplasty ◽

Wound Complications ◽

Soft Tissue Reconstruction ◽

Elbow Arthroplasty ◽

Flexor Carpi Ulnaris ◽

Tissue Reconstruction

The soft tissue at the tip of the olecranon is very thin, leading to the frequent occurrence of wound complications after total elbow arthroplasty. To cover a soft tissue defect of the elbow, the flexor carpi ulnaris muscle flap is thought to be appropriate for reconstruction of the elbow with regard to its size, location, and blood supply. We got positive clinical results, so we report our experiences of using a flexor carpi ulnaris muscle flap for soft tissue reconstruction after total elbow arthroplasty.

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