A novel splinting technique to protect flaps of the posterior lower extremity

Abstract

Dear Sirs, Protecting freshly created flaps following reconstruction of post-axial leg defects, especially on the heel and Achilles area, is a challenge. Postoperative pedicle or flap compression can cause flap loss, and in some cases limb loss. Even the best surgical and microsurgical technique can be complicated by flap loss due to postoperative compres-sion of the flap or its pedicle by the weight of the patient's leg, or by the dressings around the splint. Conventional measures to offload the reconstructed site include prolonged periods (weeks) of prone positioning, and applying external fixators to elevate the foot and prevent pedicle/flap compression.Prone positioning is poorly tolerated and arguably inhumane. External FIG URE 1 A: The two inner rings of a multi-ring foam head-positioning pillow are used to make struts to pad the splint. B: One of the struts is placed at the heel, and the other at the mid-calf. C: When applied, the splint and the struts allow the reverse sural artery perforator flap to be suspended and protected from pressure Microsurgery 2017; 37: 467-468 wileyonlinelibrary.com/journal/micr

Updates in Traumatic Lower Extremity Free Flap Reconstruction

“…In cases of flap coverage for the anterior, medial, or lateral leg or foot, a plaster posterior slab splint can be used, with the foot maintained in proper dorsiflexion to prevent equinus. 47 A loosely fit or opened Multi-Podus boot can be used in a similar manner.…”