Best Local Flaps for Lower Extremity Reconstruction

AlMugaren, Faris M.; Pak, Changsik John; Suh, Hyunsuk Peter; Hong, Joon Pio

doi:10.1097/gox.0000000000002774

Cited by 55 publications

(60 citation statements)

References 60 publications

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“…It is our experience that patients are more receptive to linear scars compared to sheet scars (Fig 4). Furthermore, the local ap advancement in the reconstruction of soft-tissue defects can readily achieve an ideal reconstructive goal (replace like-with-like) and avoid large areas of pigmentation and skin color differences, which may be caused by skin graft [19]. In the present study, we performed VSS score and SCAR score for 12 patients with ASS core (mean, 6.7; range, 5-8) and SCAR core (mean, 7.3; range, 6-9), and all patients were satis ed with the appearance of the donor site.…”

Section: Discussionmentioning

confidence: 99%

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Cai

Liu

et al. 2021

Preprint

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Purpose: With the development of microsurgical techniques, the anterolateral thigh (ALT) flap has been widely used in reconstruction of various soft-tissue defects. However, there were few studies focusing on the closure of the ALT flap donor site, especially when the width of the harvested ALT flap was more than 6 cm. The purpose of this study was to share our experience of using Keystone Design Perforator Island Flap (KDPIF) to repair the ALT flap donor site where can’t be closed without a skin graft.Method: A retrospective study was used to analyze 12 patients who underwent the reconstruction of the ALT flap donor site using KDPIF from February 2018 to December 2020. Demographics, flap characteristics, surgical technique, postoperative complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score were statistically analyzed.Results: 12 patients (10 males, 2 females) with the mean age 47.5 years (range, 27-66 years) were included in this study. All ALT flap donor sites were closed by the KDPIF. The mean size of the harvested ALT flap (the donor site size) was 8.1 cm × 14.4 cm (range from 8.0 cm × 11.0 cm to 9.0 cm × 21.0 cm), and the mean size of keystone flap was 9.1 cm × 16.4 cm (range from 8.0 cm × 13.0 cm to 12.0 cm × 19.0 cm). At the mean follow-up of 8.3 months (range, 6-12 months), two patients suffered from the skin infection around the flap, which was controlled under the treatment of wound dressing change and oral antibiotics. Wound dehiscence, osteofascial compartment syndrome (OCS), venous return disorder, and skin necrosis were not presented in any patients. All patients were evaluated at the final follow-up with ASS core (mean, 6.7; range, 5-8) and SCAR core (mean, 7.3; range, 6-9).Conclusion: This study demonstrated that the KDPIF that can be used to close the ALT flap donor site primarily is an effective and alternative treatment for patients with a the width of the donor site more than 6 cm including the advantages of high survival rate, low morbidity, good aesthetics, and simple operation.

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Section: Discussionmentioning

confidence: 99%

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Cai

Liu

et al. 2021

Preprint

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“…Using the perforator vessels allow this procedure to be used in most parts of the body, particularly the lower extremities, which are considered the largest donor site in the body for perforator flap harvest. [21] The propeller design provides the ability to cover 360 degrees of the surrounding tissue, and the free-style can be used to maneuver the flap into a viable space. Furthermore, if the defect is too large, more than one free-style propeller flap can be used.…”

Section: Discussionmentioning

confidence: 99%

Treating surgical site infection following posterior instrumentation with free-style deepithelialized propeller flap: A case report

2021

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Surgical site infection is a challenging situation for all types of surgeons. Extensive debridement with or without implant removal can create soft tissue defects. A well-vascularized, adequate soft tissue is needed to cover the wound and to fill the dead space for proper healing. Herein, we describe our approach to a large posterior trunk defect with dead space and our solution to manage an intraoperative complication using a free-style deepithelialized propeller flap.

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“…Some authors have argued that perforator flaps, in general, should be reserved for small- to medium-sized defects in the extremities defined as 14.8-1240.0 cm 2 [ 12 ]. From this standpoint, perforator flaps can be raised as surgeons approach recipient vessels, under the guidance of CT, ultrasound, or indocyanine-green angiography [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The emergence of the use of perforator flaps for the distal lower extremity has recently erupted within the literature. When choosing these flaps, AlMugaren et al suggest choosing a flap that is “technically simple, single-staged, replaces like with like, minimizes donor-site morbidity, and results in a functional, esthetic outcome” [ 13 ]. In our case, other lower-extremity flap options included posterior tibial, anterior tibial, and reverse sural flaps.…”

Section: Discussionmentioning

confidence: 99%

“…In our case, other lower-extremity flap options included posterior tibial, anterior tibial, and reverse sural flaps. The decision was made utilizing one of the three major vessels with closest proximity to the defect, allowing for a shorter arc, achieving a reliable reconstruction with like-to-like principles, decreasing dead space, utilizing more lax tissues, and dissecting the flap in a way to allow for adequate venous drainage [ 13 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

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A Propeller Perforator Flap in the Distal Lower Extremity: An Alternative to Free Flap Coverage Near the Ankle

Aukerman

Urias

Winegardner

et al. 2021

Cureus

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As perfusion assessment technologies and microsurgical techniques have evolved, plastic surgeons have become increasingly aggressive and creative in offering reconstructive solutions to limb salvage problems. In the distal lower extremity, pedicled perforator flap transfer has grown in popularity as compared to the historically reliable option of free tissue transfer. Pedicled perforator flaps typically avoid muscle harvest and restore the thin, supple soft tissue in the distal extremity, where there is a relative lack of redundancy of soft tissues. They also allow for a shorter operative time and recovery in otherwise complex wounds of the foot and ankle. This case report highlights the indications, nuance, and post-operative course of a patient who underwent peroneal perforator flap for coverage of a complex ankle wound in the setting of a calcaneal fracture.

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Best Local Flaps for Lower Extremity Reconstruction

Cited by 55 publications

References 60 publications

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Treating surgical site infection following posterior instrumentation with free-style deepithelialized propeller flap: A case report

A Propeller Perforator Flap in the Distal Lower Extremity: An Alternative to Free Flap Coverage Near the Ankle

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