Different surgical procedures for reconstruction of soft-tissue defects around the ankle

Noaman, Hassan Hamdy; Mohamed, Mohamed A; Ahmed, Faiz; Soroor, Yasser Osman

doi:10.1016/j.injury.2022.03.066

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…Early soft tissue coverage is important for obtaining good function without complications when treating a severe open injury of the lower extremity [ 1 , 2 ]. Although simple and reliable pedicled gastrocnemius muscle flaps can be used for the reconstruction of the proximal part of the lower leg, it is often difficult to reconstruct the soft tissue defect using a pedicled flap from the middle third of lower leg to the foot because of the thin soft tissue and poor blood circulation [ 3 , 4 ]. Although various reconstruction procedures, such as the reverse sural arterial flap, perforator flap, and free flap (FF), have been reported for treating soft tissue defects from the middle third of the lower leg to the foot [ 5 – 8 ], the decision about the best procedure can be complicated by the risk that flap failure can lead to serious complications such as osteomyelitis and amputation when used for severe lower leg and foot injuries [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

Ota,

Motomiya,

Watanabe

et al. 2024

BMC Musculoskelet Disord

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Background The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction. Methods We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis. Results The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases. Conclusions Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction. Data access statement The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

Ota,

Motomiya,

Watanabe

et al. 2024

BMC Musculoskelet Disord

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Propeller flap's assisted recipient site closure after free SCIP flap coverage of medial ankle defect: A case report

Meroni,

Scaglioni

2024

Microsurgery

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Defects in the distal lower limbs are common in the field of orthoplastic reconstruction. The ankle area presents little subcutaneous tissue and is often affected by high‐energy traumas and bone fractures. Wounds in this region are frequently associated with severe edema that might prevent primary closure. Due to its thinness and tension, the skin overlying both the medial and lateral malleoli is prone to necrosis, which can further lead to large soft tissue defects. Vessels, nerves, and tendons can easily become exposed. The reconstructive approach should aim to provide high‐quality tissue that is durable enough to withstand the weight‐bearing pressures and the friction from shoes, while remaining sufficiently elastic to conform to the shape of the ankle and to permit the foot movement. In this study, we describe the use of an additional propeller flap to reduce skin tension at the recipient site. A superficial circumflex iliac artery perforator (SCIP) flap was utilized to cover a defect below the medial malleolus. However, after flap inset, achieving a primary closure of the proximal wound without tension was not possible. During the dissection of the posterior tibial artery, perforator vessels were identified and preserved. The larger of these vessels was then used to vascularize a propeller flap, which was then rotated toward the defect to aid a tension‐free closure. The postoperative course was uneventful. This case may provide a valuable insight into the challenges often faced during wound closure, even after flap inset. Since the flap itself may increase the width of the dissection area, the present case shows the importance of preserving perforator vessels during the proximal dissection since they can allow the harvest of an additional flap to achieve primary closure and further alleviate tension.

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Usefulness of external fixation and reverse Sural fasciocutaneous flap: Treatment of grade III B open tibial fractures in resource-limited settings

Perdomo-Lizarraga,

Andrade-Orellano,

Necchi

et al. 2024

Injury

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Different surgical procedures for reconstruction of soft-tissue defects around the ankle

Cited by 3 publications

References 17 publications

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

Propeller flap's assisted recipient site closure after free SCIP flap coverage of medial ankle defect: A case report

Usefulness of external fixation and reverse Sural fasciocutaneous flap: Treatment of grade III B open tibial fractures in resource-limited settings

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