Combined versus Single Perforator Propeller Flaps for Reconstruction of Large Soft Tissue Defects: A Retrospective Clinical Study

Sufficient wound closure of large soft tissue defects remains a challenge for reconstructive surgeons. We aimed to investigate whether combined perforator propeller flaps (PPFs) are suitable to expand reconstructive options. Patients undergoing PPF reconstruction surgery between 2008 and 2021 were screened and evaluated retrospectively. Of 86 identified patients, 69 patients received one perforator propeller flap, while 17 patients underwent combined PPF reconstruction with multiple flaps. We chose major complications as our primary outcome and defined those as complications that required additional surgery. Postoperatively, 27 patients (31.4%) suffered major complications. The propeller flap size, the type of intervention as well as the operation time were not associated with a higher risk of major complications. A defect size larger than 100 cm2, however, was identified as a significant risk factor for major complications among single PPFs but not among combined PPFs (OR: 2.82, 95% CI: 1.01−8.36; p = 0.05 vs. OR: 0.30, 95% CI: 0.02−3.37; p = 0.32). In conclusion, combined PPFs proved to be a reliable technique and should be preferred over single PPFs in the reconstruction of large soft tissue defects at the trunk and proximal lower extremity.

Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

The possibility of using autologous adipose tissue for the stage shin wound closing

Extensive soft tissue defects can be complicated by systemic diseases (trophic ulcers in diabetes mellitus, chronic arterial insufficiency) or the result of trauma (domestic, military, operating, etc.). The current increase in the incidence of this pathology is due to the spread of cardiovascular diseases and diabetes mellitus. Closing an infected long-term non-healing wound, such as a tendon or bone, is one of the most difficult tasks of reconstructive surgery. For example, the use of classical methods of closing wound conditions is difficult to a degree due to the patient's polymorbid background. The clinical case presented in the article shows the possibility of closing deep shin wound with a complex relief by the transplantation of autologous adipose tissue, a patient with severe concomitant pathology.

Wound Healing and Therapy in Soft Tissue Defects of the Hand and Foot from a Surgical Point of View

Wounds and tissue defects of the hand and foot often lead to severe functional impairment of the affected extremity. Next to general principles of wound healing, special functional and anatomic considerations must be taken into account in the treatment of wounds in these anatomical regions to achieve a satisfactory reconstructive result. In this article, we outline the concept of wound healing and focus on the special aspects to be considered in wounds of the hand and foot. An overview of different treatment and dressing techniques is given with special emphasis on the reconstruction of damaged structures by plastic surgical means.

Clinical application of retrograde sural neurofasciocutaneous flap repair combined with jingulian capsules to treat foot and ankle soft tissue defects

Objectives: To observe and analyse the efficacy of retrograde sural neurofasciocutaneous flap repair combined with Jingulian capsules to treat foot and ankle soft tissue defects. Methods: One hundred and eighty patients with foot and ankle soft tissue defects were enrolled in the study from January 2016 to June 2019 in The Second Department of General Surgery,Baoding First Central Hospital. They were divided into a study group and a reference group with the same case number. The former group was provided combination treatment, i.e. retrograde sural neurofasciocutaneous flap repair combined with Jingulian capsules; the latter group was given vacuum sealing drainage. Then, the treatment outcomes of the two groups were compared. Results: The study group needed fewer dressing changes, less preoperative preparation time and antibiotic use than the reference group, p<0.05. The study group had a significantly lower incidence of wound infections and flap necrosis than the reference group, p<0.05. The study group was significantly superior to the reference group regarding ankle function scores and the pain visual analogue scores (VAS) p<0.05. Conclusions: Retrograde sural neurofasciocutaneous flap repair combined with Jingulian capsules is a protocol that improves efficacy for soft tissue defects in the foot and ankle, which are worthy of promotion and practice. doi: https://doi.org/10.12669/pjms.38.1.4546 How to cite this:Hao Z, Tian S, Hu C, Jia Y. Clinical application of retrograde sural neurofasciocutaneous flap repair combined with jingulian capsules to treat foot and ankle soft tissue defects. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4546 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.